The introduction of endovascular aortic repair has revolutionised the treatment of abdominal aortic aneurysms, replacing open surgical repair for the majority of elective cases due to its optimal morbidity and mortality. Several endovascular aortic repair stent grafts exist commercially, one of which is the Fenestrated Anaconda™ by Terumo Aortic which benefits from a very innovative design, unique custom-made approach and highly favourable results.
Aims
The main scope of this narrative review is to provide a comprehensive overview of endovascular aortic repair clinical outcomes using the Fenestrated Anaconda™ stent-graft and comparing these with its market competitor, Zenith. This review will also examine the evidence in the literature on the Anaconda™'s custom-made approach.
Methods
A comprehensive literature was conducted on several search engines including PubMed, Google Scholar, Ovid, Scopus and Embase to collate the evidence in the literature on clinical outcomes achieved with the Fenestrated Anaconda™ and Zenith including, but not limited to, survival, technical success, target vessel patency, endoleak, reintervention and aneurysm sac regression.
Results
The Fenestrated Anaconda™ is associated with excellent results, including highly favourable survival, technical and clinical success and target vessel patency rates, very low need for reintervention or conversion, and minimal incidence of complications such as endoleak and endograft migration. The Fenestrated Anaconda™ also drives significant sac regression and aortic remodelling. In addition, its unique custom-made approach enables it to treat highly complex aortic anatomy as well as to ‘rescue’ failed competitor grafts.
Conclusion
The Fenestrated Anaconda™ has proven that it is a very safe, highly applicable and extremely effective device used for complex aortic and/or iliac pathology based on its novel design and outstanding track record of clinical outcomes.
LiXZhaoGZhangJ,et al.Prevalence and trends of the abdominal aortic aneurysms epidemic in general population—a meta-analysis. PloS One2013; 8: e81260.
2.
HirschATHaskalZJHertzerNR, et al. ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic). Circulation2006; 113: e463–e654.
DemangetNDupreyABadelP, et al. Finite element analysis of the mechanical performances of 8 marketed aortic stent-grafts. J Endovasc Ther Off J Int Soc Endovasc Spec2013; 20: 523–535.
9.
FreyrieAGargiuloMRossiC, et al. Preliminary results of Anaconda aortic endografts: a single center study. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg2007; 34: 693–698.
10.
EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet Lond Engl2005; 365:2179–2186.
11.
BlankensteijnJDde JongSECAPrinssenM, et al. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med2005; 352: 2398–2405.
12.
SaratzisNMelasNSaratzisA, et al. Anaconda aortic stent-graft: single-center experience of a new commercially available device for abdominal aortic aneurysms. J Endovasc Ther Off J Int Soc Endovasc Spec2008; 15: 33–41.
13.
StellaAFreyrieAGargiuloM,et al.The advantages of Anaconda endograft for AAA. J Cardiovasc Surg (Torino) 2009; 50: 145–152.
14.
RödelSGJGeelkerkenRHPrescottRJ, et al. The Anaconda AAA stent graft system: 2-year clinical and technical results of a multicentre clinical evaluation. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg2009; 38: 732–740.
15.
KarkosCDKapetaniosDMAnastasiadisPTh, et al. Endovascular repair of abdominal aortic aneurysms with the AnacondaTM stent graft: mid-term results from a single center. Cardiovasc Intervent Radiol2015; 38: 1416–1424.
16.
DijkstraMLTielliuIFJMeerwaldtR, et al. Dutch experience with the fenestrated Anaconda endograft for short-neck infrarenal and juxtarenal abdominal aortic aneurysm repair. J Vasc Surg2014; 60: 301–307.
17.
FreyrieAGallittoEGargiuloM, et al. Results of the endovascular abdominal aortic aneurysm repair using the Anaconda aortic endograft. J Vasc Surg2014; 60: 1132–1139.
18.
FreyrieAGargiuloMFargionA, et al. AnacondaTM: the Italian Registry. Study protocol and preliminary perioperative results. J Cardiovasc Surg (Torino)2011; 52: 629–635.
19.
MidyDBastrotLBelhommeD, et al. Five year results of the French EPI-ANA-01 registry of AnacondaTM endografts in the treatment of infrarenal abdominal aortic aneurysms. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg2020; 60: 16–25.
20.
TigkiropoulosKStavridisKLazaridisI, et al. Outcomes of endovascular aneurysm repair using the Anaconda stent-graft. J Endovasc Ther Off J Int Soc Endovasc Spec2020; 27: 462–467.
21.
PiniRGiordanoJFerriM, et al. The Italian multicentre registry of fenestrated AnacondaTM endografts for complex abdominal aortic aneurysms repair. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg2020; 60: 181–191.
22.
IserniaGSimonteGMichelagnoliS, et al. Nineteen-year outcomes with the Anaconda stent graft system from two tertiary centers. J Vasc Surg2021; 74: 105–113.
23.
de NietAZeebregtsCJReijnenMMPJ, Fenestrated Anaconda study group. Outcomes after treatment of complex aortic abdominal aneurysms with the fenestrated Anaconda endograft. J Vasc Surg2020;72: 25–35.e1.
24.
RödelSGJZeebregtsCJHuismanAB,et al.Multicenter angulated neck study with the Anaconda study participants. Results of the Anaconda endovascular graft in abdominal aortic aneurysm with a severe angulated infrarenal neck. J Vasc Surg2014;59:1495–1501, 1501.e1.
25.
RollsAEJenkinsMBicknellCD, et al. Experience with a novel custom-made fenestrated stent graft in the repair of juxtarenal and type IV thoracoabdominal aneurysms. J Vasc Surg2014; 59: 615–622.
ShahverdyanRGrayDGawendaM,et al.Single centre results of total endovascular repair of complex aortic aneurysms with custom made Anaconda fenestrated stent grafts. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg2016; 52: 500–508.
28.
KotelisDSchleimerKFoldenauerC, et al. Operative and midterm outcomes of the fenestrated Anaconda stent-graft in the endovascular treatment of juxtarenal, suprarenal, and type IV thoracoabdominal aortic aneurysms. J Endovasc Ther Off J Int Soc Endovasc Spec2016; 23: 930–935.
29.
ColganFEBungayPMBurfittN, et al. Operative and 1-year outcomes of the custom-made fenestrated Anaconda aortic stent graft—a UK multicenter study. Ann Vasc Surg2018; 46: 257–264.
30.
MidyDBecqueminJPMialheC, et al. Results of the French multicentric study of ANACONDATM fenestrated endografts in the treatment of complex aortic pathologies (EFEFA Registry). Ann Vasc Surg2017; 43: 151–165.
31.
de NietAReijnenMZeebregtsC. The Fenestrated AnacondaTM for the treatment of complex abdominal aortic aneurysms. Endovasc Today2018; 6(1). Published online February 1.
32.
VerziniFRomanoLParlaniG, et al. Fourteen-year outcomes of abdominal aortic endovascular repair with the Zenith stent graft. J Vasc Surg2017; 65: 318–329.
33.
VäärämäkiSSaleniusJPPimenoffG,et al.Systematic long-term follow up after endovascular abdominal aortic aneurysm repair with the Zenith stent graft. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg2019; 58: 182–188.
34.
KawamataHTajimaHUedaT, et al. Long-term outcomes of endovascular aortic aneurysm repair with the Zenith AAA endovascular graft: a single-center study. Jpn J Radiol2020; 38: 77–84.
35.
OderichGSFarberMASchneiderD, et al. Final 5-year results of the United States Zenith fenestrated prospective multicenter study for juxtarenal abdominal aortic aneurysms. J Vasc Surg2021; 73: 1128–1138.e2.
36.
BungayPMBurfittNSritharanK, et al. Initial experience with a new fenestrated stent graft. J Vasc Surg2011; 54: 1832–1838.
37.
de NietAReijnenMMPJZeebregtsCJ, Fenestrated Anaconda cuff study group. Early results with the custom-made Fenestrated Anaconda aortic cuff in the treatment of complex abdominal aortic aneurysm. J Vasc Surg2019; 69: 348–356.
38.
VukovicECzernyMBeyersdorfF, et al. Abdominal aortic aneurysm neck remodeling after Anaconda stent graft implantation. J Vasc Surg2018; 68: 1354–1359.e2.
39.
StehrASchnitzbauerAASteinbauerMG, et al. Early experience shows rapid shrinking of abdominal aortic aneurysms after endovascular treatment with Anaconda device. VASA Z Gefasskrankheiten2007; 36: 199–204.
40.
FalkensammerJTaherFUhlmannM,et al.Rescue of failed endovascular aortic aneurysm repair using the Fenestrated Anaconda device. J Vasc Surg2017; 66: 1334–1339.
41.
ZamirMJenkinsMBurfittN,et al.Short-term and midterm results of fenestrated Anaconda endograft in patients with previous endovascular aneurysm repair. J Vasc Interv Radiol JVIR2019; 30: 546–553.
42.
RödelSGJZeebregtsCJMeerwaldtR,et al.Incidence and treatment of limb occlusion of the Anaconda endograft after endovascular aneurysm repair. J Endovasc Ther Off J Int Soc Endovasc Spec2019; 26: 113–120.
43.
LeeuwerkeSJGde NietAGeelkerkenRH, et al. Incidence and predictive factors for endograft limb patency of the fenestrated Anaconda endograft used for complex endovascular aneurysm repair. J Vasc Surg2022; 75: 1512–1520.e1.
44.
de NietADonselaarEJHolewijnS, et al. Endograft conformability in fenestrated endovascular aneurysm repair for complex abdominal aortic aneurysms. J Endovasc Ther2020; 27: 848–856.
45.
CrawfordSAItkinaMDoyleMG,et al.Structural implications of fenestrated stent graft misalignment. Surg J R Coll Surg Edinb Irel2018; 16: 89–93.
46.
JettyPHusereauDKansalV,et al.Variability in aneurysm sac regression after endovascular aneurysm repair based on a comprehensive registry of patients in Eastern Ontario. J Vasc Surg2019; 70: 1469–1478.
47.
BogdanovicMStackelbergOLindströmD, et al. Limb graft occlusion following endovascular aneurysm repair for infrarenal abdominal aortic aneurysm with the Zenith alpha, excluder, and Endurant devices: a multicentre cohort study. Eur J Vasc Endovasc Surg2021; 62: 532–539.
48.
SinghAMafeldSWilliamsR,et al.Physician-modified fenestrated endografts for managing the ruptured or symptomatic aortic aneurysm: technique overview and clinical outcomes. Vasc Endovascular Surg2018; 52: 607–612.
49.
MafeldSLakshminarayanRKimCN,et al.Iliac fenestration—an alternative endovascular option for common iliac aneurysms. Ann Vasc Surg. 2019;60:476.e1–476.e6.
50.
KarathanosCKaperonisEXanthopoulosD, et al. Endovascular treatment of isolated iliac artery aneurysms with Anaconda stent graft limb. Case Rep Vasc Med2013; 2013: 527492.
51.
PowerAHRapanosTMooreR,et al.Anaconda endovascular limbs for the treatment of isolated iliac artery aneurysms. Vascular2009; 17: 23–28.
52.
PapoianSAShchegolevAAChernaiaNR,et al.Endoprosthetic repair of iliac artery aneurysm with a branch of the Anaconda stent graft. Angiol Sosud Khirurgiia Angiol Vasc Surg2021; 27: 152–157.
