Expanded Suitability of Ruptured Abdominal Aortic Aneurysms for Total Endovascular Repair Using the Endurant Endograft and Heli-FX EndoAnchors

Abstract

Purpose: To assess if the suitability of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs) can be expanded by combining the Endurant stent-graft with the Heli-FX EndoAnchors. Materials and Methods: Contrast-enhanced computed tomography (CT) scans of 90 patients (mean age 73.2±9 years; 87 men) with RAAA admitted between January 2014 and January 2018 in 2 tertiary care centers were analyzed in a 3-dimensional workstation. Anatomical features of the aneurysms according to the instructions for use (IFU) for the Endurant endograft were evaluated and expansion of treatment with Heli-FX EndoAnchors was assessed. Results: Neck length <10 mm was present in 41 (45.6%) patients; 5 had neck diameters outside the IFU and 45 (50.0%) had conical necks. Thrombus and calcium were absent in 63 (70.0%) and 73 (81.1%), respectively. In the study cohort, 44 (48.9%) patients met all the neck criteria, although overall IFU compliance was found in only 35 (38.9%) patients due to iliac-related issues in 21 patients. The adjunctive use of EndoAnchors in the entire study group would enhance the therapeutic range to an additional 24 patients, 8 of whom would need an associated iliac procedure. This represents an expansion of the total EVAR approach from 48.9% to 75.6% of cases if some iliac issues are overcome and from 38.9% to 56.7% without correcting iliac deficiencies. Conclusion: The main reason of being unfit for endovascular treatment in this series was neck length <10 mm. Based on this analysis, nearly 40% of RAAA patients would have been candidates for EVAR based on the IFU neck criteria for the Endurant stent-graft. This suitability could be nearly doubled with the use of EndoAnchors and correction of unsuitable iliac anatomy. The use of EndoAnchors has the potential to offer a significant benefit in the endovascular treatment of RAAA patients.

Anesthetic, Sedation, and Analgesic Technique for Successful Local Anesthetic EndoSuture Aneurysm Repair

“…Within its evidence review is the non-randomized IMPROVE trial, which suggests that EVAR under LA for RAAA may have lower short-term mortality than EVAR under GA [18]. In a recent review of CT scans of 90 patients with RAAA, of the 46 patients who were unsuitable for conventional EVAR, 24 could have been treated with ESAR, an absolute increase of 27% [7]. Regardless of the long-term role of EAs, LA-ESAR could be applied to these patients with RAAA.…”

“…However, EVAR provides better outcomes than open surgical repair (OSR) in ruptured AAA (RAAA), with a potentially increased benefit if EVAR is performed under local anesthesia (LA) [ 6 ]. It has been postulated that ESAR might expand the indications of EVAR among patients with RAAA [ 7 ]. Therefore, it is essential to be able to achieve ESAR without general anesthesia (GA), as the ability to perform the procedure under LA is an advantage of EVAR over OSR.…”

Endovascular aortic repair with EndoAnchors demonstrate good mid-term outcomes in physician-initiated multicenter analysis—The PERU registry

“…ESAR should not be considered a competitive but indeed a complementary technique that is both useful and accessible/available when hostile neck anatomic features are encountered, and correct technical deployments are accomplished, 4,29 avoiding potential complications of other complex techniques. 30,31 We aim to keep data inclusion open for all centers that want to participate on this multicenter collaboration.…”

Aneurysms and dissections - What is new in the literature of 2019/2020 - a European Society of Vascular Medicine annual review

“…In the meantime, the device has been removed from the market. Reyes Valdivia et al demonstrated that the suitability of EVAR of rAAA can be expanded by combining the Endurant stent-graft with the Heli-FX EndoAnchors and Galinanes et al used such EndoAnchors to minimize endoleaks in chimney-graft endovascular repair of juxtarenal AAA [168,169]. However, Goudeketting revealed that almost 30% of EndoAnchors had been maldeployed outside of the recommended use [170].…”