Aorfix™ device for abdominal aortic aneurysm with challenging anatomy

Anatomical characteristics of abdominal aortic aneurysms (AAA) are the most critical factors for successful endovascular aortic repair (EVAR). Of these, severe proximal aortic neck angulation and iliac axis tortuosity increase the complexity of EVAR. Neck angulation seems to have a pivotal potential for fixation failure, a situation that may lead to complications, including endoleak and late rupture. Bench-test studies identified that the relative stiffness of a stent-graft was responsible for its inability to conform to neck angulation, therefore creating leaks through gaps between the stent graft and the neck. Aorfix™ stent graft (Lombard Medical, Didcot, UK) is a flexible stent-graft designed and manufactured with the purpose of overcoming the issue of stent-graft stiffness. Many studies have shown good results in term of procedural success and mid-term type-I endoleak. PYTHAGORAS trial evaluated mainly patients with highly angulated infrarenal neck and showed that high performance of Aorfix™ stent graft did not present any significant difference between neck >60° and <60°. In the series of 27 patients treated at our Institution we had a primary technical success of 96.3% and an assisted primary technical success of 100%. In this review we will analyze the available data in literature regarding Aorfix™ stent graft and will discuss the outcome of the patients treated with Aorfix™ stent graft at our centre.