Frank Arko (Charlotte, USA) presented one-year results from the 70-patient short-neck cohort of the ANCHOR Registry. Patients were treated with an endograft and endoanchors (Endurant and Heli-FX, Medtronic) for abdominal aortic aneurysm. The data showed “very good clinical outcomes in a challenging patient population”, Arko reported, and suggested a new term be added to the endovascular lexicon to name the procedure: endosuture aneurysm repair, or ESAR.
Short-neck patients from the registry were defined as having necks of less than 10mm, with a minimum of 4mm. The proximal neck diameter was “right around 26mm, and the average neck length 7mm”, Arko said. The average aneurysm size was 5.8cm. The endoanchors were described by Arko as a “complementary option for the short-neck patient; Endurant is on label to 10mm, and with the addition of the endoanchor it allows you to treat down to a 4mm neck.”
In the overall one-year outcomes for the short-neck cohort, average duration of procedure time was 148 minutes—not “that much of an increase”, Arko commented. Patients received an average of 5.5 endoanchor implants. Technical and procedural success was high, with 88.6% (62/70) and 97.1% (68/70), respectively. Type Ia endoleak incidence was low at one year, with 1.9% which Arko mentioned is consistent with alternative treatment options including FEVAR and chEVAR. Endograft migration was 0% and need for secondary procedures at the one-year follow-up was 4.7%.
“Nearly all patients had stabilisation or decreasing of the sac, with 43% decreasing in size”, Arko said. Freedom from all-cause mortality was 93%, and freedom from aneurysm-related mortality was 94.3%, with no aneurysm ruptures. “Most deaths were related to perioperative implant procedure,” Arko added, “and as 17% of patients in the registry were actually symptomatic, these were not all elective cases.”
“In theory,” he argued, “endoanchor implants
increase the seal zone and provide radial fixation, and we also believe it prevents neck dilatation in this dilating disease. For patients with neck lengths less than 10mm, the endograft plus the endoanchor for this is advantageous, because it applies for patients who present symptomatically or emergently; it is ‘off-the-shelf’ and expands patient applicability; it has very good clinical results in the ANCHOR short-neck cohort at one year; and it decreases the complexity costs and resource utilisation within the hospital system compared to alternative therapies. Finally, it really allows us to evolve our therapy and really simulate open surgical repair.”
Speaking about the technique applied in the trial, using endoanchors in combination with the stent graft for repair in this type of short-neck abdominal aneurysm patient, Arko concluded that a new term is appropriate to describe it: “We really ought to name this, and add the term to our lexicon of aneurysm therapy—and we would like to call this ‘ESAR’: endosuture aneurysm repair”.
While one-year data is promising, the study aims to follow the 70 patients for a total of five years, to determine the longer-term safety and efficacy of the endoanchor and endograft combination therapy.