EndoAnchors in Thoracic, Thoracoabdominal, and Complex Abdominal Endovascular Aortic Repairs: Safe and Effective

Abstract

Thoracic endovascular aortic repair (TEVAR) and complex endovascular abdominal aortic repair (CEVAR) are performed despite anatomic constraints and complicated aortic disease. Using Heli-FX EndoAnchors (Medtronic, Santa Rosa, Calif) for endograft fixation in the infrarenal aorta has been described. This study was performed to assess the applicability and outcomes of EndoAnchors in TEVAR and CEVAR. This was a retrospective review of endovascular aortic repairs performed with EndoAnchors between 2012 and 2016. Primary study end points included freedom from migration and type I endoleak requiring reintervention. A total of 101 patients underwent 54 TEVARs and 47 CEVARs with EndoAnchor; 22 patients (21.8%) were treated for thoracic aortic aneurysm, 35 (34.7%) for thoracoabdominal aneurysm, 22 (21.8%) for pararenal aneurysm, and 22 (21.8%) for infrarenal aneurysms with hostile neck anatomy. There were 45 cases (44.6%) performed as index operations, and 56 (55.4%) were redo operations. TEVAR endografts were deployed in zone 0 or 1 in 40.1% of patients, requiring adjunctive procedures (arch debranching, 20; in situ arch fenestration, 9; supra-aortic trunk chimney, 4; visceral debranching, 2). In CEVAR patients, one visceral vessel was treated in 25 patients (24.8%), two in 6 patients (5.9%), three in 24 patients (23.8%), and four in 5 patients (5.0%). EndoAnchors were placed for therapeutic indications in 41.6% of cases and for prophylactic indications in 58.4%. Technical success of deployment was 99.6%. Mean follow-up was 14.3 ± 11.0 months. At 2 years, freedom from type I endoleak requiring reintervention was 93.8% for thoracic aneurysms, 100% for thoracoabdominal aneurysms, and 94.1% for abdominal aneurysms, with no significant difference in freedom from type I endoleak between redo (93.7%) and index (96.7%) operations (P = .752). EndoAnchors can be safely used in TEVAR and CEVAR and can decrease rates of graft migration and type I endoleak. Additional data and long-term follow-up are needed to further define the use of this technology.