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

Abstract

Purpose: Loss of fixation and seal represent a key problem when undertaking endovascular repair of abdominal aortic aneurysms (AAA) with hyperangulated necks (HAN). This study assesses the outcomes following the use of adjunct endostapling to supplement proximal aorto-prosthetic fixation in patients who have AAAs with HAN.

Methods: A retrospective review of a prospective database of 42 patients with HAN (> 60°) who underwent endovascular aneurysm repair (EVAR) with supplementary endostapling was undertaken. Primary outcomes assessed were: change in post-EVAR neck angulation at first post-procedure scan, freedom from type 1 endoleaks, migration and reintervention for proximal seal complications. Secondary parameters included assessment for neck dilatation, sac size changes and EndoAnchor distribution patterns.

Results: In total, 42 patients underwent EVAR between 2013 and 2019. There was one 30-day mortality resulting in 41 patients (34 male, 7 females aged 76.8 ± 8.9 years)) being analysed; 251 EndoAnchors were deployed in total, averaging 6 ± 2 per patient; 38 such cases were primary deployments. Neck angulation was 76.9 ± 14 degrees pre-EVAR and 50.2 ± 14.5 degrees post-procedure (p < .001, paired T test). Mean follow-up time was 18.5 (95% CI 13.3-23.9) months. One patient had persistent type Ia endoleak, successfully banded. There was 6.8 ± 10.2 mm sac size reduction (p < .001, paired T test). There were no other neck-related reinterventions, despite continued neck dilatation (3.2 ± 3.7 mm, p < .001, paired T test).

Conclusion: This study suggests successful EVAR with adjunct endostapling for AAA with hyperangulated necks, with significant sac shrinkage and low rates of endoleaks, migration and reinterventions. More data are needed to consider influencing current instructions for use.

Keywords: Abdominal aortic aneurysm (AAA); EndoAnchors; Endostapling; Endovascular aneurysm repair (EVAR); Hostile neck anatomy; post-operative complications.