Fenestrated Anaconda Endograft for the Treatment of Complex Aortic Aneurysms: Systematic Review and Meta-Analysis

To perform a systematic review and meta-analysis of the outcomes of Anaconda fenestrated endograft for the treatment of complex abdominal aortic aneurysms (cAAA).

A systematic search of all the literature reported until May 2024 was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The pooled 30-day mortality rate, technical success rate, reintervention rate as well as bridging stent occlusion rate, and corresponding 95% confidence intervals (CIs) were estimated using fixed or random effect methods.

A total of 526 study titles were identified by the initial search strategy, of which 6 were considered eligible for inclusion in the meta-analysis. A total of 782 patients (89% male) were identified among the eligible studies. The pooled 30-day mortality rate was 4.8% (95% CI, 3.5%-6.5%) while the reintervention rate was 7.9% (95% CI, 4.3%-14.1%) and 10.2% (95% CI, 5.8%-17.4%) in the early and late period, respectively. The pooled bridging stents occlusion was 2.7% (95% CI, 1.5%-4.9%) during 30 days and 3.5% (95% CI, 1.6%-7.6%) during follow-up. Overall technical success was 86.1% (95% CI, 62.9%-95.8%).

The use of the Anaconda fenestrated endograft in treatment of complex aortic aneurysms involving the abdominal visceral vessels has low early and late mortality. Low rate of bridging stent occlusion occurs early postoperatively and during follow-up, mostly involving the renal arteries. Reinterventions during follow-up are mostly induced by limb occlusion. Lower early technical success rate is explained by the presence of a type Ia endoleak on final angiography, which however resolves spontaneously early postoperatively.Clinical ImpactThe present systematic review and meta-analysis of observational studies provide evidence-based data regarding the safety and efficacy of the fenestrated Anaconda device for the primary treatment of cAAA in the perioperative period and at long-term follow-up. Six studies with an overall 782 patients were included. The technical success in patients with cAAA treated with Anaconda fenestrated endograft was 86% while the reintervention rate was 7.9% and 10.2 during the perioperative and long-term follow up period. The pooled 30-day occlusion rate for the bridging stents was 2.7% while the late pooled occlusion rate for the bridging stents among the studies was 3.5%. The use of the Anaconda fenestrated endograft in treatment of complex aortic aneurysms involving the abdominal visceral vessels seems feasible with promising outcomes. The lower early technical success is obscured by the presence of type Ia endoleak which, resolves spontaneously early postoperatively.