Technological Advances to Address the Challenging Abdominal Aortic Aneurysm Neck

Area of Science:

• Vascular Surgery
• Endovascular Therapy
• Aortic Aneurysm Repair

Background:

• Conventional endovascular aortic aneurysm repair (EVAR) faces limitations with hostile infrarenal aortic neck anatomy.
• Technological progress aims to overcome these challenges, enhancing treatment efficacy and safety.

Purpose of the Study:

• To review anatomical features contributing to hostile aortic necks.
• To discuss recent technological advancements in endovascular aortic therapies designed to address these limitations.

Main Methods:

• Review of anatomical factors defining a hostile aortic neck.
• Discussion of novel endovascular devices and techniques, including EndoAnchors, fenestrated EVAR (FEVAR), and multibranch grafts.

Main Results:

• EndoAnchors provide suture-like fixation, proving effective for short, angulated necks and type Ia endoleaks.
• Fenestrated EVAR (FEVAR) devices enable suprarenal sealing while preserving renal perfusion.
• Multibranch aortic grafts (e.g., Tambe) offer off-the-shelf solutions for visceral segment sealing with promising outcomes.

Conclusions:

• Recent innovations in endovascular aortic repair offer solutions for previously challenging anatomies.
• These advancements expand the applicability of EVAR, improving outcomes for patients with hostile aortic necks.