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Abstract

Objective

Endovascular aneurysm repair has gained field over open surgery for the treatment of abdominal aortic aneurysm. However, type Ia endoleak represents a common complication especially in hostile neck anatomy that is recently faced using endoanchors. We conducted a systematic review and meta-analysis to collect and analyse all the available comparative evidence on the outcomes of the endosuture aneurysm repair in patients with or without hostile neck in standard endovascular aneurysm repair.

Methods

The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All the prospective and retrospective studies reporting primary use of the Heli-FX EndoAnchor implants were considered eligible for inclusion in this study. The main study outcomes (technical success of endoanchor implantation, incidence of type Ia endoleak, aortic stent graft migration and the percentage of patients who presented regression or expansion of aneurysm sac throughout the follow-up) were subsequently expressed as proportions and 95% confidence intervals.

Results

Eight studies with a total of 968 patients were included in a pooled analysis. The technical success of the primary endoanchor fixation was 97.12% (95%CI: 92.98–99.67). During a mean six months follow-up period, a pooled rate of 6.23% (95%CI: 0.83–15.25) of the patients developed a persistent type Ia endoleak despite the primary implantation. Migration of the main graft was reported in five studies, in which a 0.26% (95%CI = 0.00–1.54) of the patients required an additional proximal aortic cuff. Regression of the aneurysm sac was observed at 68.82% (95%CI: 51.02–84.21). An expansion of the aneurysm sac was found in 1.93% (95%CI: 0.91–3.24) of the participants. The overall survival rate was 93.43% (95%CI: 89.97–96.29) at a mean six months follow-up period.

Conclusions

Endosuture aneurysm repair with the Heli-FX EndoAnchor implants seems to be technically feasible and safe either for prevention or for repair of intraoperative type Ia endoleak. Despite the primary implants of endoanchors, few cases of persistent type Ia endoleak and migration are still conspicuous. Long-term follow up is needed to determinate the role of this therapeutic option in the treatment of aortic aneurysms.

Keywords

Endoanchor EVAR abdominal aortic aneurysm Heli-FX EndoAnchor implants endosuture aneurysm repair

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References

Antoniou

Georgiadis

Antoniou

, et al. A meta-analysis of outcomes of endovascular abdominal aortic aneurysm repair in patients with hostile and friendly neck anatomy. J Vasc Surg 2013; 57: 527–538.

Hobo

Kievit

Leurs

, et al. Influence of severe infrarenal aortic neck angulation on complications at the proximal neck following endovascular AAA repair: a EUROSTAR study. J Endovasc Ther 2007; 14: 1–11.

Schanzer

Greenberg

Hevelone

, et al. Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation 2011; 123: 2848–2855.

de Vries

Ouriel

Mehta

, et al. Analysis of EndoAnchors for endovascular aneurysm repair by indications for use. J Vasc Surg 2014; 60: 1460–1467.

Jordan

Jr de Vries

Ouriel

, et al. Midterm outcome of EndoAnchors for the prevention of endoleak and stent-graft migration in patients with challenging proximal aortic neck anatomy. J Endovasc Ther 2015; 22: 163–170.

Liberati

Altman

Tetzlaff

, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700.

Cook

Reed

DA.

Appraising the quality of medical education research methods: the Medical Education Research Study Quality Instrument and the Newcastle-Ottawa scale-education. Acad Med 2015; 90: 1067–1076.

Jordan

Jr Mehta

Varnagy

, et al. Results of the ANCHOR prospective, multicenter registry of EndoAnchors for type Ia endoleaks and endograft migration in patients with challenging anatomy. J Vasc Surg 2014; 60: 885 e2–892 e2.

Valdivia

Beropoulis

Pitoulias

, et al. Multicenter registry about the use of EndoAnchors in the endovascular repair of abdominal aortic aneurysms with hostile neck showed successful but delayed endograft sealing within intraoperative Type Ia endoleak cases. Ann Vasc Surg 2019; 60: 61–69.

10.

Arko

III Stanley

Pearce

, et al. Endosuture aneurysm repair in patients treated with Endurant II/IIs in conjunction with Heli-FX EndoAnchor implants for short-neck abdominal aortic aneurysm. J Vasc Surg 2019; 70: 732–740.

11.

Muhs

Jordan

Ouriel

, et al. Matched cohort comparison of endovascular abdominal aortic aneurysm repair with and without EndoAnchors. J Vasc Surg 2018; 67: 1699–1707.

12.

Tassiopoulos

Monastiriotis

Jordan

, et al. Predictors of early aortic neck dilatation after endovascular aneurysm repair with EndoAnchors. J Vasc Surg 2017; 66: 45–52.

13.

Mehta

Henretta

Glickman

, et al. Outcome of the pivotal study of the Aptus endovascular abdominal aortic aneurysms repair system. J Vasc Surg 2014; 60: 275–285.

14.

Perdikides

Melas

Lagios

, et al. Primary endoanchoring in the endovascular repair of abdominal aortic aneurysms with an unfavorable neck. J Endovasc Ther 2012; 19: 707–715.

15.

Deaton

Mehta

Kasirajan

, et al. The phase I multicenter trial (STAPLE-1) of the Aptus endovascular repair system: results at 6 months and 1 year. J Vasc Surg 2009; 49: 851–857. discussion 7-8.

16.

Powell

Sweeting

Ulug

, et al. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years. Br J Surg 2017; 104: 166–178.

Outcomes of endosutured aneurysm repair with the Heli-FX EndoAnchor implants

Abstract

Objective

Methods

Results

Conclusions

Keywords

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References