Aorfix™ device for abdominal aortic aneurysm with challenging anatomy

Area of Science:

• Vascular Surgery
• Medical Device Technology
• Aortic Aneurysm Treatment

Background:

• Anatomical factors like aortic neck angulation and iliac tortuosity complicate endovascular aortic repair (EVAR).
• Stent graft stiffness can lead to fixation failure and complications such as endoleak and rupture in angulated necks.
• The Aorfix™ stent graft was developed to address stiffness issues and improve conformability in complex aortic anatomy.

Purpose of the Study:

• To review the literature on the Aorfix™ stent graft's performance in endovascular aortic repair.
• To analyze outcomes of patients treated with the Aorfix™ stent graft at the authors' institution, focusing on challenging anatomies.
• To evaluate the efficacy of the Aorfix™ stent graft in managing severe proximal aortic neck angulation.

Main Methods:

• Literature review of studies on the Aorfix™ stent graft, including procedural success and endoleak rates.
• Analysis of data from the PYTHAGORAS trial concerning patients with highly angulated infrarenal necks.
• Retrospective analysis of 27 patients treated with the Aorfix™ stent graft at the authors' institution.

Main Results:

• The Aorfix™ stent graft has shown good procedural success and mid-term Type-I endoleak rates in various studies.
• The PYTHAGORAS trial indicated high performance of the Aorfix™ stent graft regardless of neck angulation severity (>60° vs. <60°).
• In the authors' series, primary technical success was 96.3%, with assisted primary technical success reaching 100%.

Conclusions:

• The Aorfix™ stent graft is a flexible option that effectively addresses challenges posed by aortic neck angulation in EVAR.
• Available data and institutional experience suggest favorable outcomes and high technical success rates with the Aorfix™ stent graft.
• The device shows promise in reducing complications associated with complex aortic neck anatomy during endovascular repair.