Primary Use Of Endoanchor Fixation In Patients With Hostile Aortic Neck Anatomy Offers Protection From Proximal Seal Zone Complications
Ronak Patel, MD, Avigayil Ribner, MD, Georgios Tzavellas, MD, Angela Kokkosis, MD, Mohsen Bannazadeh, MD, Apostolos Tassiopoulos, MD.
Stony Brook University Hospital, Stony Brook, NY, USA.
OBJECTIVES: Proximal seal zone (PSZ) failures resulting in Type 1A endoleaks remain 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 proximal seal and fixation but their role in protecting the integrity of the PSZ is not clearly defined. We report the mid-term results of primary use of endoanchors in a patient cohort with hostile neck anatomy in our institution.
METHODS: This is a retrospective analysis of prospectively collected data of patients who underwent EVAR with primary use of Endoanchors between 2014-2019 at our tertiary care center. All patients had at least 1 year follow up that included CT scan one month and one year postoperatively, and annual imaging with CT or duplex ultrasound thereafter. All patient deaths and aneurysm-related reinterventions were reviewed. Aneurysm sac maximum diameter was measured preoperatively, one year postoperatively, and at the longest follow up CT. PSZ integrity was also assessed for Type 1A endoleaks, graft migration, and proximal neck dilation.
RESULTS: A total of 25 patients met inclusion criteria. Endoanchors were used prophylactically in 7 patients for short and angulated (1), short and conical (1), short (1), wide (2), and conical (2) necks. In 18 patients, Endoanchors were placed for intraoperative Type 1A endoleaks which were felt to result from a dilated neck (2), short neck (4), highly angulated neck (8), or a combination of more than one hostile neck characteristic (4). Three intraoperative Type 1A endoleaks occurred in patients presenting with rupture. Median operating time was 158 minutes and median length of stay was one day. Median follow up was 42 months (range 12-75 months). At one year, 92% (23/25) of patients exhibited aneurysm sac regression with a mean diameter decrease of 10.9mm. During the follow up period, 28% (7/25) patients required aneurysm-related reinterventions; none, however for PSZ failure. Five deaths occurred during the follow up period, with no aneurysm-related deaths.
CONCLUSIONS: Endoanchors, as adjuncts to EVAR in patients with hostile neck anatomy, offer protection against endograft migration and PSZ failure in mid-term follow up. Their use is a reasonable alternative for patients with hostile neck anatomy who may not be candidates for open or other complex endovascular repair.
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