Five-year outcomes of ESAR in patients with short neck

Frank R. Arko

Cohort analysis shows no migrations, a low rate of ruptures, and positive sac regression, researchers say.

Five-year outcomes in patients with short neck abdominal aortic aneu­rysms (AAAs) undergoing endosuture aneurysm repair (ESAR) using Heli-FX En­doAnchors with an Endurant stent-graft in the ANCHOR registry showed a freedom from all-cause mortality of nearly 70%, from aneurysm-related mortality of 90%, from aneurysm rupture of 95.6%, and from any secondary procedures of 77%, lead study author Frank R. Arko, MD— who disclosed a consultancy relationship with and receiving research funds from device maker Medtronic—told SAVS 2023.

The cohort, with a mean age of 72, included 70 patients with an infrarenal neck length greater than 4mm and less than 10mm enrolled from 2012–2015 and fitted with the Heli-FX EndoAnchor system, which was designed to improve the fixation and seal of aortic stent-grafts. At five years, the patient group had clinical and imaging follow up compliance rates of 85% and 70%.

Some 11 patients had a total of 16 sec­ondary procedures. None of the conver­sions had open repair that were for type Ia endoleaks, although there were patients who had this type of endoleak, Arko said. “The type of secondary procedures were endovascular in the majority, and there were three conversions to open repair.”

Through five years, eight had type Ia en­doleaks, three of which were resolved by the next follow-up, reported the vascular chief from Sanger Heart & Vascular Insti­tute in Charlotte, North Carolina. There were two type Ib endoleaks, 13 patients who had a type II, and there were no type III endoleaks.

After five years, 68.2% of the registry subjects had sac regres­sion, 13.6% had stable sacs, and 18.2% had increased sac diam­eter as compared to their one-month measurements, the study authors showed.

“Patients with infrarenal necks of between 4 and 10mm implanted with the Endurant II/IIs in combination with the Heli-FX EndoAnchor system showed durability of treatment through five years,” Arko concluded before the SAVS 2023 gathering in Rio Grande, Puerto Rico. “There is a need for close and lifelong surveillance in these patients with hostile necks due to occurrence of late events that appears to be appearing at around the three-year time period.

“The study is certainly limited by the small sample size and further prospective randomized con­trolled trials are needed, and these will be performed in the near future.”


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