Evaluation of EndoAnchor Aortic Wall Penetration After Thoracic Endovascular Aortic Repair

Abstract

Purpose: To analyze aortic wall penetration of Heli-FX EndoAnchors after use in seal zones in the aortic arch or descending thoracic aorta during thoracic endovascular aortic repair (TEVAR). Materials and Methods: From May 2014 to May 2019, 25 patients (mean age 70.5±10 years; 16 women) were treated with TEVAR and adjunctive use of the Heli-FX device in 3 academic vascular surgery departments. Computed tomography scans were retrospectively reviewed to determine the location [arch or descending thoracic aorta (DTA)] of the EndoAnchors and the adequacy of aortic wall penetration, defined as adequate (≥2 mm), partial (<2 mm), or inadequate wall penetration (including loss). Endoleaks, reinterventions, and mortality were assessed. Results: A total of 161 EndoAnchors were deployed (median 7 per patient, range 4–9). Twenty-two EndoAnchors were place in the arch (zones 0–2) and 139 in the DTA (zones 3–5). A larger proportion of arch deployments (27%) had suboptimal penetration compared with the DTA (6.5%; p<0.005), resulting in a 91% adequate wall penetration rate for the series overall. Three EndoAnchors were lost (and only 1 retrieved) in 3 different patients, with no additional morbidity; thus, an overall deployment success rate of 88% was achieved. At a mean follow-up of 16.6±14 months, 4 patients required 5 (successful) reinterventions, including one for a type Ia endoleak treated with chimney TEVAR. One patient died 10 months after treatment due to endograft infection, without an opportunity for surgical correction. Conclusion: EndoAnchors have a higher risk of maldeployment in the arch, though this may be attributable to the small learning curve experience in this location. The best aortic wall penetration for this series was in the DTA, where EndoAnchors proved useful for distal endograft fixation during TEVAR.

Mid-term outcomes of the use of endoanchors during thoracic endovascular aortic repair in multicentre analysis

“…The current series including 54 patients describes an acceptable 88% freedom from TIEL at 2 year follow-up and an overall EndoAnchor adequate AWP of 86%, evaluated at first CT scan. In our previous early report including only 25 patients, 21 total series adequate AWP was achieved in 90.7% although there was a significant difference for arch deployments (72.7%) versus dTA (93.5%). In the current series, there were no statistical differences between arch versus dTA deployments for AWP (there was a tendency towards more incomplete penetration in arch cases, though); however, the comparison between nine arch cases and 45 dTA might be still non-comparable.…”

Type 1 Endoleak: Management following Thoracic Endovascular Aortic Repair

“…Finally, endoanchoring is technically feasible but should also be seen as a last resort and not as a first option, due to the known limitations. 14 …”

“…Finally, endoanchoring is technically feasible but should also be seen as a last resort and not as a first option, due to the known limitations. 14 Parallel grafts: parallel grafts, due to their inefficacy, have also been largely abandoned and should only be used in acute clinical scenarios where no other options are available. 4…”

Preoperative Planning for EndoAnchor Use During Thoracic Endovascular Aortic Repair in the Distal Aortic Arch

“…7 However, clinical experience with EndoAnchors in the aortic arch is still limited, and initial studies report difficulties achieving correct deployment. 8…”