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Anatomic Characteristics of the Proximal Aortic Neck in Patients Treated with EndoAnchors for Prevention of Endoleak and Migration
William D. Jordan, MD1, Jean-Paul JM de Vries, MD, PhD2, Manish Mehta, MD, MPH3, David Varnagy, MD4, William M. Moore, Jr., MD5, Frank R. Arko, MD6, James Joye, DO7, John Henretta, MD8.
1University of Alabama at Birmingham, Birmingham, AL, USA, 2St. Antonuis Hospital, Nieuwegein, Netherlands, 3Center for Vascular Awareness, Albany, NY, USA, 4Florida Hospital, Orlando, FL, USA, 5Lexington Medical Center, West Columbia, SC, USA, 6Carolinas Health Care System, Charlotte, NC, USA, 7El Camino Hospital, Mountain View, CA, USA, 8Mission Hospital, Asheville, NC, USA.
Objectives: The outcome of endovascular repair of abdominal aortic aneurysms (EVAR) is, in part, dependent on the anatomy of the proximal aortic neck (PAN). EndoAnchors (Aptus Endosystems, Sunnyvale, CA) have been employed to prevent endoleak and migration in patients with hostile PAN anatomy.
Methods: Pre-procedure baseline 3D-reformatted CT scans were evaluated by an independent core laboratory in 100 patients undergoing primary EVAR with EndoAnchors in the ANCHOR Global Registry. Median CT slice thickness was 1.5 mm and aortic diameter was assessed at 5 mm increments from the renal arteries to the aneurysm sac. PAN length was defined as the aortic centerline length where diameter remained within 10% of the immediate infrarenal diameter. Infrarenal tortuosity index was calculated as the ratio of the curvilinear (centerline) to straight length from the infrarenal location to a point 40 mm distal to the end of the PAN. Hostile PAN were defined as length <10 mm, diameter >28mm, angulation >60 degrees, thrombus or calcium over >50% circumference, or an increase in aortic diameter >10% over the first 10 mm below the lowest renal artery (conical configuration). Values are expressed as median and interquartile range.
Results: The median PAN length was 10.8 mm (7.1, 22.7 mm). Neck length was ≤10 mm in 45 patients and ≤5 mm in 14 patients. The median infrarenal aortic neck diameter was 25.8 mm (23.5, 29.0 mm), with suprarenal angulation of 13 degrees (9, 22 degrees) and infrarenal angulation of 22 degrees (14, 35 degrees). Neck thrombus and calcium ≥2 mm thickness was present in 19 and 32 patients and covered 36% and 10% of the neck circumference, respectively. The infrarenal tortuosity index was 1.04 (1.02, 1.08). PAN were conical in 43 cases. Overall, 79 cases met the criteria for a hostile PAN. No type 1a endoleaks (site-reported) were observed on the first post-procedure CT scan in any patient.
Conclusions: The PAN anatomy of patients treated with EVAR in ANCHOR Registry was quite challenging, with short length, large diameter, significant thrombus/calcium, or conical configuration in 79% of cases. Despite the vast majority of patients meeting the criteria for a hostile PAN, early type 1a endoleaks were not observed. Definitive results, however, must await the availability of long-term outcome.
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