Midterm Single-Center Results of Endovascular Aneurysm Repair With Additional EndoAnchors

Seline R. Goudeketting*, Jan Wille, Daniel A. F. van den Heuvel, Jan-Albert Vos, Jean-Paul P. M. de Vries

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)

Abstract

Purpose: To review midterm clinical outcomes of EndoAnchor placement during or after endovascular aneurysm repair (EVAR) or chimney EVAR (ch-EVAR). Materials and Methods: A retrospective analysis was conducted of 51 consecutive patients [median age 75 years; 38 men] who underwent EVAR/ch-EVAR with EndoAnchor placement between June 2010 and December 2016 to prevent seal failures (31, 61%) or to treat type Ia endoleak and/or migration (20, 39%). Median aortic neck diameter was 27.7 mm and median neck length was 9.0 mm. Thirty-three (65%) had a conical neck; 48 (94%) had at least 1 hostile neck characteristic. Thirty-two (63%) patients had severe comorbidities (ASA score > III). Eight patients had a single ch-EVAR procedure. Baseline patient characteristics, anatomic variables, procedure details, early and late complications, reinterventions, and aneurysm-related and all-cause mortality rates were recorded. Follow-up imaging was performed with computed tomography angiography (CTA) or duplex ultrasonography. Results: Median procedure time was 100 minutes; a median of 6 EndoAnchors were implanted. There were 10 (10%) residual type Ia endoleaks at the end of the procedure; 9 had resolved by the first postoperative CTA. One residual and 2 new type Ia endoleaks were identified at the first postoperative imaging. Median follow-up for the entire cohort was 24.0 months, during which 3 new type Ia endoleaks were identified. Five of the 6 type Ia endoleaks were treated, 1 resolved spontaneously. There was 1 endograft limb occlusion without clinical consequences, 1 chimney graft occlusion without possibilities for a reintervention, 1 rupture after type IV endoleak (a Nellix device was successfully deployed within the main device), and 1 complete graft explantation for infection. There was no new-onset hemodialysis. Kaplan-Meier estimates of freedom from type Ia endoleak, proximal neck-related reinterventions, and aneurysm-related mortality at 2 years were 87.3%, 92.2%, and 94.0%, respectively. Conclusion: EndoAnchors are helpful in the endovascular treatment of unfavorable proximal aortic necks, with fair midterm results.

Original languageEnglish
Pages (from-to)90-100
Number of pages11
JournalJournal of Endovascular Therapy
Volume26
Issue number1
DOIs
Publication statusPublished - Feb-2019

Keywords

  • abdominal aortic aneurysm
  • chimney grafts
  • complications
  • endoanchor
  • endograft
  • endoleak
  • endovascular aneurysm repair
  • hostile neck
  • reintervention
  • stent-graft
  • ABDOMINAL AORTIC-ANEURYSM
  • NECK
  • HOSTILE
  • ENDOSTAPLES
  • PREVENTION
  • MIGRATION
  • FIXATION
  • STANDARD
  • ENDOLEAK
  • OUTCOMES

Cite this