The use of EndoAnchors in endovascular repair of abdominal aortic aneurysms with challenging proximal neck: Single-centre experience

Abstract

Objectives The aim of this study was to present a single-centre experience with EndoAnchors in patients who underwent endovascular repair for abdominal aortic aneurysms with challenging proximal neck, both in the prevention and treatment of endograft migration and type Ia endoleaks. Methods We retrospectively analysed 17 consecutive patients treated with EndoAnchors between June 2015 and May 2018 at our institution. EndoAnchors were applied during the initial endovascular aneurysm repair procedure (primary implant) to prevent proximal neck complications in difficult anatomies (nine patients), and in the follow-up after aneurysm exclusion (secondary implant) to correct type Ia endoleak and/or stent-graft migration (eight patients). Results Mean time for anchors implant was 23 min (range 12–41), with a mean of 5 EndoAnchors deployed per patient. Six patients in the secondary implant group required a proximal cuff due to stent-graft migration ≥10 mm. Technical success was achieved in all cases, with no complications related to deployment of the anchors. At a median follow-up of 13 months (range 4–39, interquartile range 9–20), there were no aneurysm-related deaths or aneurysm ruptures, and all patients were free from reinterventions. CT-scan surveillance showed no evidence of type Ia endoleak, anchors dislodgement or stent-graft migration, with a mean reduction of aneurysm diameter of 0.4 mm (range 0–19); there was no sac growth or aortic neck enlargement in any case. Conclusions EndoAnchors can be safely used in the prevention and treatment of type Ia endoleaks in patients with challenging aortic necks, with good results in terms of sac exclusion and diameter reduction in the mid-term follow-up.

Endograft platform does not influence aortic neck dilatation after infrarenal endovascular aneurysm repair with primary endostapling

“…This study does not have full long-term follow-up for all patients beyond five years due to the failures in survival and loss to follow-up, as is typical of real-world data. However, the presented series is larger than most other single-centre [38][39][40][41] or even multicentre 32 studies that have been presented outside of the ongoing ANCHOR registry, 42 which examine primary endostapling and affirm good mid-term results. We have not assessed suprarenal AND because of a mix SRF/IRF devices being used, which do not provide comparable suprarenal aortic stressors.…”

Editor's Choice – Systematic Review of the Use of Endoanchors in Endovascular Aortic Aneurysm Repair

“…Avci et al 16 de Vries et al 12 Giudice et al 11 Ho et al 14 Total (random effects) 17 Ongstad et al 18 Ho et al 14 Total (random effects) There are several important limitations of this review; the most significant being the lack of case controlled and long term follow up data. Longer follow up data from the AN-CHOR registry, out to 36 months, were presented at the 2018 VEITH symposium.…”

“…Interstudy heterogeneity required judgement regarding which studies to include in meta-analysis (rationales are detailed below). Seven EVAR 6,7,9,11,12,14,16 and three TEVAR studies 14,17,18 were included in the meta-analysis.…”

“…Deaton et al 6 Mehta et al 7 Galinanes et al 9 de Vries et al 12 Giudice et al 11 Ho et al 14 Total (random effects) Figure 2. Forest plots of pooled rate of (A) type Ia endoleak and (B) graft migration in patients who underwent endovascular aortic aneurysm repair and primary endoanchor fixation.…”

Computational analysis of endovascular aortic repair proximal seal zone preservation with endoanchors: A case study in cylindrical neck anatomy

“…In an attempt to address the rate of type 1 endoleaks, endoanchors were developed to secure the proximal endograft to the aortic wall. 13 The helical screws are indicated for patients with hostile neck geometry, 14 that is, those with short, wide, conical, or hyperangulated necks, but routine EVAR procedure patients also benefit. 12 , 13 The addition of endoanchors at the proximal seal zone, as a preventative measure or treatment of type 1a endoleaks, has low adverse event rates and is successful.…”