Incidence and Treatment of Limb Occlusion of the Anaconda Endograft After Endovascular Aneurysm Repair

Abstract

To evaluate the incidence and treatment of limb occlusions of the second-and third-generation Anaconda endografts. Methods: A single-center retrospective study was conducted involving 317 consecutive patients (mean age 76 years; 289 men) who underwent endovascular aneurysm repair for elective asymptomatic, symptomatic intact, and ruptured infrarenal abdominal aortic aneurysm with 2 versions of the Anaconda device. From September 2003 to July 2011, the second-generation device was used in 189 patients (mean age 77 years; 169 men) and from July 2011 to September 2015, the third-generation device was implanted in 128 patients (mean age 75 years; 120 men). The rates of limb occlusion were compared between groups and according to compliance with the instructions for use (IFU); predictors were sought in multivariate analysis. The results of the latter are given as the hazard ratio (HR) and 95% confidence interval (CI). Results: Kaplan-Meier freedom of occlusion estimates for second-and third-generation devices, respectively, was 96.6% and 95.0% at 1 year, 89.9% and 95.0% at 2 years, and 86.5% and 88.6% at 5 years. There was no significant difference in overall occlusion rate between the second-generation devices (p=0.332) or with regard to use within the IFU (p=0.827); however, there was a clinically relevant decrease in the occlusion rate for elective patients treated with the third-generation device (6.4% vs 13.1%, p=0.077). There was an increase in the occlusion rate when the iliac limb diameter was ≤13 mm. In multivariate analysis, the only independent predictor of limb occlusion was a small distal prosthesis diameter (HR 0.732, 95% CI 0.63 to 0.86, p<0.001). Symptomatic nonruptured and ruptured abdominal aortic aneurysm (AAA) interventions had an almost 2-fold increased risk of occlusion (HR 1.95, 95% CI 0.93 to 4.11, p=0.078), though this did not reach statistical significance. Conclusion: The Anaconda design has proven effectiveness in AAA exclusion in daily practice inside the IFU. However, efforts could be made to further reduce the limb occlusion rate.

Five Year Results of the French EPI-ANA-01 Registry of AnacondaTM Endografts in the Treatment of Infrarenal Abdominal Aortic Aneurysms

“…24 Recently, Rödel et al focused on this specifically and reported a 9.8% rate of index occlusions over a mean follow up of 47 months. 32 They showed no significant difference in overall occlusion rate between the second and third generation Anaconda devices, or with use within the IFU or not. No endograft escapes this complication, 33 and Faure et al looked for predictive factors for limb occlusion in various types of endografts.…”

Outcomes of Endovascular Aneurysm Repair Using the Anaconda Stent-Graft

“…Extreme iliac artery angulation >60%, circumferential calcification or thrombus >50%, extreme iliac limb graft oversizing, and extension to the external iliac artery are factors contributing to iliac limb thrombosis. 18 Rodel et al 19 evaluated the incidence and treatment of limb graft occlusions of the second- and third-generation Anaconda stent-grafts. No significant difference in overall occlusion rate between the second-generation devices or with regard to IFU compliance was reported; however, there was a decrease in the occlusion rate for elective patients treated with the third-generation device.…”

Incidence and predictive factors for endograft limb patency of the fenestrated Anaconda endograft used for complex endovascular aneurysm repair

“…43 Possibly related to this, the second-generation infrarenal Anaconda™ endograft was prone to limb occlusion, thought to be related to compression of the limbs due to a mismatch between the J o u r n a l P r e -p r o o f smaller main body and relatively large limb diameters. 17,44 To allow for easier limb size selection, the third-generation graft (ONE-LOCK™) was launched in 2011, with a standardized proximal docking zone and different types of distal limb configurations (straight, flared or tapered). 17 Most of the reported experience with the Anaconda™ endograft comes from secondgeneration devices.…”

“…17,44 To allow for easier limb size selection, the third-generation graft (ONE-LOCK™) was launched in 2011, with a standardized proximal docking zone and different types of distal limb configurations (straight, flared or tapered). 17 Most of the reported experience with the Anaconda™ endograft comes from secondgeneration devices. 15,16,24,25 Only one reported study has included only third-generation devices 23 and a few studies included mixed populations.…”

“…[9][10][11][12] Despite a good overall performance, relatively high rates of limb occlusion are seen in both the infrarenal and Fenestrated Anaconda™; up to 14% and 23% respectively. 9,11,[13][14][15][16][17][18][19][20][21][22][23][24][25] The aim of this study was to describe the incidence, risk factors, and outcomes of treatment for limb occlusion, in patients treated for complex AAA with the Fenestrated Anaconda™.…”