Off Label Use of EndoAnchors for the Treatment of Abdominal Aortic Aneurysm With Large-Barrel Neck

EVAR has replaced open surgical repair as the most commonly preferred definitive therapy for abdominal aortic aneurysm (AAA)s with suitable anatomy. However, the hostile neck has its own challenges in terms of treatment. Several endovascular techniques have been applied successfully to some of these hostile necks; however, none of these techniques are known to be used for large barrel necks. We presented a 73-year-old male with a large barrel neck AAA that was successfully treated with EVAR with EndoAnchors. Final procedural angiogram showed that the use of EndoAnchors were successful to completely exclude the aneurysms without evidence of endoleak. One-year follow-up CT revealed complete thrombosis of the aneurysmal sac and freedom from endoleak. EndoAnchors might be used to treat some large barrel neck AAAs. Through this case, we propose that the suitable anatomy would be: Diameter of "secondary neck" of less than 32 mm, absence of circumferential calcification and thrombus > 2 mm, the length of the "secondary neck" of at least 4 mm, and position of the secondary neck within 40-50 mm below the lowest renal artery.