Endoanchor system associated with favorable outcomes after AAA repair

An endoanchor system demonstrated positive outcomes and durability in patients with complex aortic abdominal aneurysm anatomy, according to three presentations at VEITHsymposium.

The presentations evaluated the effects of the endoanchor system (Heli-FX and Heli-FX Thoracic, Medtronic), an endovascular deployed anchor that attaches aortic endografts to the vessel wall, simplifying procedures for patients with complex anatomy, according to a press release issued by Medtronic.

Outcomes improved

Bart Muhs, MD, PhD , a vascular surgeon at The Vascular Experts in Middletown, Connecticut, presented data from a propensity-matched analysis. Patients from the ANCHOR registry who had received implants with the endoanchor system (n = 99) during an endovascular aneurysm repair (EVAR) were compared with controls who had been treated in the 4 years before the endoanchor system was available (n = 99).

Muhs and colleagues found a statistically significant difference in sac regression (endoanchor, 28.6%; control, 20.3%; P = .017). Though not statistically significant, the researchers also found less proximal neck dilation (98.4% vs. 94.9%; P = .35) and low rates of Type Ia endoleaks (freedom from leaks in endoanchor group, 97%; controls, 94.1%; P = .725).

“This propensity-matched data from the ANCHOR registry shows that the Heli-FX EndoAnchor system improves patient outcomes based on key measures of effectiveness,” Muhs said in the release. “Our analysis reflects real-world clinical experience, and provides the next level of clinical evidence supporting this endoanchor system in patients with complex, hostile abdominal aortic aneurysms.”

Benefit for short necks

A presentation by William D. Jordan, Jr., MD, professor and chief of the division of vascular surgery and endovascular therapy, Emory University, Atlanta, showed data from patients who had very short necks and received the endoanchor system.

Patients were evaluated in three groups: those who received the system prophylactically at the same time as EVAR (n = 314); those who received the system as a therapeutic primary for a Type Ia endoleak occurring immediately after EVAR (n = 123); or those who received the system as a therapeutic revision during a follow-up visit to treat a post-EVAR complication (n = 167). The patients were followed up at 1 and 2 years.

Jordan said in the prophylactic group, the rate of type 1a endoleaks was 0.6% at 1 year and 0% at 2 years, the rate of positive sac regression was 45.6% at 1 year and 61.2% at 2 years, the rate of freedom from secondary procedures was 95.9% at 1 year and 92.1% at 2 years, and the rate of freedom from aneurysm-related mortality was 98.4% at 1 year and 2 years.

In the therapeutic primary group, he said, the rate of type 1a endoleaks was 1.4% at 1 year and 2.9% at 2 years, the rate of positive sac regression was 43.1% at 1 year and 51.4% at 2 years, the rate of freedom from secondary procedures was 97.9% at 1 year and 92.9% at 2 years, and the rate of freedom from aneurysm-related mortality was 98.4% at 1 year and 2 years.

In the therapeutic revision group, he said, the rate of type 1a endoleaks was 19.2% at 1 year and 11.1% at 2 years, the rate of positive sac regression was 16.9% at 1 year and 37.9% at 2 years, the rate of freedom from secondary procedures was 84.8% at 1 year and 79.9% at 2 years, and the rate of freedom from aneurysm-related mortality was 96.5% at 1 year and 92.6% at 2 years.

Neck dilation

Apostolos K. Tassiopoulos, MD, professor and chief of the division of vascular surgery at Stony Brook Medicine, Stony Brook, New York, presented data on the effect of the endoanchor system on neck dilation.

Tassiopoulos said independent risk factors for aortic neck dilation between 1 month and 12 months were aortic diameter at the lowest renal level (P < .001) and endograft oversizing (P = .001), while protective factors included aortic neck length (P = .021) and number of endoanchors placed (P = .037).

“Neck length and endoanchors appear to offer a protective effect towards aortic neck dilatation,” he said at the presentation. “Long-term follow-up studies are necessary to evaluate the progression of dilatation at different levels of the aortic neck and the effect of endoanchors on the stability of the repair.” – by Cassie Homer and Erik Swain

References:

Jordan WD, et al. Muhs BE, et al. Tassiopoulos AK, et al. Session 61: Endoleaks and Endograft Migration: Update on EndoAnchors. All presented at: VEITHsymposium; Nov. 15-19, 2016; New York.

Disclosures: The studies were funded by Medtronic. Jordan reports serving as a clinical investigator and/or consultant for Aptus, Cordis, Endologix, Lombard, Medtronic, Terumo, Trivascular and W.L. Gore & Associates; all fees are paid to his institution. Muhs reports consulting for Cook Medical, Endologix and Medtronic. Tassiopoulos reports consulting for Medtronic.