EndoAnchors in Thoracic, Thoracoabdominal and Complex Abdominal Endovascular Aortic Repairs: Safe and Effective
Sarah B. Ongstad, MD, Daniel Miller, DO, Sebastian Larion, MD, Jean M. Panneton, MD.
EVMS, Norfolk, VA, USA.
OBJECTIVES: Thoracic endovascular aortic repair (TEVAR) and complex endovascular abdominal aortic repair (CEVAR) are performed despite anatomic constraints and complicated aortic pathology. The use of the Heli-FX EndoAnchor System to improve endograft fixation in the infrarenal aorta has previously been described. The goal of this study was to assess the applicability and outcomes of EndoAnchor use in TEVAR and CEVAR.
METHODS: A retrospective review was performed of all endovascular aortic repairs performed with EndoAnchors between December 2012 and June 2016. Primary study endpoints included freedom from migration and from type I endoleak requiring reintervention.
RESULTS: A total of 101 patients underwent 54 TEVARs and 47 CEVARs with EndoAnchor fixation. Twenty-two patients (21.8%) were treated for thoracic aortic aneurysm, 35 patients (34.7%) for thoracoabdominal aneurysm, 22 patients (21.8%) for pararenal aneurysm and 22 patients (21.8%) for infrarenal aneurysms with hostile neck anatomy. Thirty patients (29.7%) were symptomatic at presentation and 6 patients (5.9%) were ruptured. Forty-five cases (44.6%) were performed as index operations and fifty-six cases (55.4%) were redo operations. TEVAR endografts were deployed in zones 0 or 1 in 40.1% of patients and required a number of adjunctive procedures (arch debranching = 20, in-situ arch fenestration = 9, supra-aortic trunk chimney = 4, visceral debranching = 2). In patients who received CEVAR, 1 visceral vessel was treated in 25 patients (24.8%), 2 vessels in 6 patients (5.9%), 3 vessels in 24 patients (23.8%), and 4 vessels in 5 patients (5.0%). A total of 930 EndoAnchors were placed. EndoAnchors were placed for therapeutic indications in 41.6% of cases and for prophylactic indications in 58.4% of cases. Technical success of EndoAnchor deployment was 99.6%. Mean follow-up was 14.3±11.0 months. There was one instance (1.0%) of graft migration with type Ia endoleak. At 2 years, freedom from type I endoleak requiring reintervention was 93.8% for thoracic aneurysms, 100% for thoracoabdominal aneurysms at 94.1% for abdominal aneurysms with no significant difference found in freedom from type I endoleak between redo (93.7%) and index (96.7%) operations (p=0.752).
CONCLUSIONS: EndoAnchors can be safely utilized in TEVAR and CEVAR to enhance endograft durability by decreasing rates of graft migration and type I endoleak. Additional data and long-term follow-up are needed to further define the use of this technology.
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