Primary Use of Endoanchors in Patients With Hostile Aortic Neck Anatomy Offers Protection from Proximal Seal Zone Complications
Avigayil Ribner, MD, Georgios Tzavellas, MD, Angela Kokkosis, MD, Apostolos Tassiopoulos, MD.
Stony Brook University Hospital, Stony Brook, NY, USA.
Objectives: Proximal seal zone failures resulting in Type IA endoleaks remains a significant challenge after endovascular abdominal aortic aneurysm repair (EVAR), particularly in patients with hostile neck anatomy. Endoanchors have been utilized in recent years to improve endograft seal and fixation. We reviewed the mid-term results of primary use of endoanchors in patients with hostile proximal neck anatomy in our hospital.
Methods: This is a retrospective analysis of prospectively collected data in 20 patients who underwent EVAR with use of Endoanchors at a single tertiary care center between 2014- 2018. All patients were followed postoperatively with a CT scan (1 month and 1 year postoperatively) and duplex ultrasound (6 months postoperatively and annually thereafter). All patient deaths and aneurysm-related reinterventions were captured from the electronic medical record. Aneurysm sac maximum diameter was measured in every postoperative imaging study and aneurysm sac volumetric measurements were performed using TeraRecon on the preoperative and one year postoperative CT angiograms.
Results: Endoanchors were placed prophylactically in 4 EVAR patients for short and angulated (1), short and conical (1), dilated (1), and highly angulated (1) necks and for intraoperative Type IA endoleaks in 16 patients. Type IA endoleaks were felt to result from an aggressively oversized endograft (1), dilated neck (1), short neck (5), conical neck (1), highly-angulated neck (2), circumferential calcium (1), or a combination of more than one hostile neck characteristic (4). Median operating time was 185 minutes and median length of stay was one day. At one year follow up, 83% (15/18) of AAAs showed diameter decrease and 53% (7/13) sac volume reduction. Mean follow up was 24 months (range 2-45 months). During the follow up period, 35% (7/20) patients required aneurysm-related reinterventions, none for proximal seal zone complications. Six deaths occurred in the late postoperative period, none aneurysm related. Furthermore, there were no patients with endograft migration, proximal seal zone failure, or aneurysm rupture.
Conclusion: Endoanchors, as adjuncts to EVAR in patients with hostile proximal neck anatomy, offer protection against endograft migration and proximal seal zone failure in mid-term follow up. Their use should be considered as an alternative solution for patients who may not qualify for open AAA repair or other complex endovascular procedures.
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