Improved Midterm Outcomes Using Standard Devices and EndoAnchors for Endovascular Repair of Abdominal Aortic Aneurysms with Hyperangulated Necks

The Impact of EndoAnchor Penetration on Endograft Structure: First Report of Explant Analysis

“…The EA IFU recommends distributing the EA implants as regularly as possible around the circumference of the sealing stent, 1 with recent recommendations to use columnar endostapling for hostile neck anatomy. 3 , 5 Even though the delivery system allows accurate placement, it may be difficult to know where exactly the tip of the screw will engage in terms of fabric and stent metal. Consequently, the risk of penetrating the endograft structure close to the ligature threads and/or the stents is not negligible and can sometimes immediately result in maldeployment issues such as migration and on table EA fracture.…”

“… 7 These results directly suggest that good positioning and deployment of the anchor requires specialised skills and a trained team, with experts suggesting a multiplanar approach for hostile necks. 3 , 5 However, the design of these studies did not integrate the long term cyclic load, but focused on traction resistance that results in exposure to forces much higher than in vivo forces and did not integrate the arterial cyclic load, which created the lesions observed. However, it is worth considering that optimal EA deployment achieves good aorto–graft apposition, reinforcing the suggestion of the protective effect of EAs even with continued aortic neck dilatation, 3 , 8 which may be an effect of both static (radial force) and cyclic (haemodynamic) loading.…”

“…EA deployment needs to be accurately planned out, because “blind” placement might lead to persistent complications requiring complex open revisional surgery in high risk patients. 3 Clinical studies, especially long term, are therefore needed to assess the safety and efficiency of this system on short neck aneurysms. 3 , 9 …”

“…1 The use of EAs has been shown to be feasible and safe, with at least comparable early outcomes to the latest generation of stent grafts. 2 , 3 However, the rate of type Ia endoleak after secondary fixation remains about 22.6% and adverse events include EA fractures, EA dislocation, or EA entrapment. 2 Moreover, current evidence lacks long term follow up and perhaps case controlled trials are recommended for EA use in routine practice, although this is already integrated in some.…”

“… 2 Moreover, current evidence lacks long term follow up and perhaps case controlled trials are recommended for EA use in routine practice, although this is already integrated in some. 3 , 4 …”