EndoAnchors for Prevention and Treatment of Proximal Seal Failure in EVAR: A Mid-term Single-Center Experience

BackgroundThis study assesses the efficacy of Heli-FX EndoAnchors (EA) in the prevention and treatment of proximal failures after endovascular aortic aneurysm repair (EVAR).MethodsOutcomes of 92 consecutive patients treated with EAs, between June 2010 and March 2018, were retrospectively analyzed. The EAs were deployed during primary EVAR (primary arm [PA]) or revisions for failing proximal fixation (revision arm [RA]). The primary endpoint was freedom from type 1a endoleak (T1aEL) and/or stent-graft migration; secondary end points were proximal reintervention-free survival and overall survival.ResultsThe median follow-up among the 92 patients was 4.1 years (interquartile range=2.0-6.4). The PA consisted of 73 patients, of which 85% had hostile infrarenal neck morphology. In the RA, 19 patients received EAs, combined with an infrarenal extension cuff in 90% of cases. Treatment success, defined as absence of T1aEL on the first (<60 days) post-operative imaging studies, was 97% in the PA and 74% in the RA, respectively. Five-year freedom from T1aEL and/or stent-graft migration was 87.3% in the PA and 58.8% in the RA. Overall survival at 5 years was 65.1% and 51.4% in the PA and RA, respectively, and freedom from proximal reintervention was 89.3% in the PA and 79.7% in the RA.ConclusionsIn this single-center retrospective series, EndoAnchors used during primary EVAR in hostile neck anatomy demonstrated high mid-term freedom from T1aEL and/or stent-graft migration. The use of EAs to treat proximal failure of aortic endografts showed less benefit. In these complex cases, fenestrated EVAR or open repair may be more appropriate.Clinical ImpactThis study demonstrates that the use of EndoAnchors during primary endovascular aortic aneurysm repair (EVAR) is associated with high mid-term freedom from type 1a endoleaks and stent-graft migration. These findings suggest that EndoAnchor placement may improve EVAR durability, particularly in patients with hostile neck anatomy, and reduce the need for secondary interventions in this high-risk group. In contrast, the more limited benefit observed in revision settings highlights the need to carefully consider alternative treatment strategies when treating proximal failure after EVAR.