Endosutured aneurysm repair (ESAR) of abdominal aortic aneurysms with short necks achieves acceptable mid-term outcomes - results from the PERU registry

Andrés Reyes Valdivia; Kyriakos Oikonomou; Ross Milner; Apostolos Pitoulias; Michel M P J Reijnen; Karin Pfister; Giovanni Tinelli; Csaba Csobay-Novák; Giovanni Pratesi; Luis Mariano Ferreira; Jean-Paul P M de Vries; Arindam Chaudhuri; Contributors

doi:10.1016/j.avsg.2024.01.002

Endosutured aneurysm repair (ESAR) of abdominal aortic aneurysms with short necks achieves acceptable mid-term outcomes - results from the PERU registry

Ann Vasc Surg. 2024 Apr 3:S0890-5096(24)00118-3. doi: 10.1016/j.avsg.2024.01.002. Online ahead of print.

Collaborators

Contributors:
Richte Schuurmann¹³, Claudio Gandarias Zúñiga¹⁴, Ayman Badawy¹⁵, Martina Bastianon¹⁶, Miguel Ferrer¹⁷, Daniele Mariastefano Fontanini¹⁸

Affiliations

¹ Department of Vascular and Endovascular Surgery. Ramón y Cajal´s University Hospital, Madrid, Spain. Electronic address: cauzaza@hotmail.com.
² Department of Vascular and Endovascular Surgery, Cardiovascular Surgery Clinic, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt. Electronic address: kyriakos.oikonomou@kgu.de.
³ Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Chicago Medicine, Chicago, Ill. Electronic address: rmilner@surgery.bsd.uchicago.edu.
⁴ Department of Vascular and Endovascular Surgery, Research Vascular Center, Asklepios Clinic Langen, Langen, Germany. Electronic address: appitoulias@yahoo.com.
⁵ Department of Surgery, Rijnstate, Arnhem and the Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands. Electronic address: mmpj.reijnen@gmail.com.
⁶ Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany. Electronic address: karin.pfister@ukr.de.
⁷ Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: Giovanni.tinelli@policlinicogemelli.it.
⁸ Semmelweis Aortic Center, Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary. Electronic address: csobay.csaba@semmelweis.hu.
⁹ a)Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, b)IRCCS Ospedale Policlinico San Martino, Genoa. Electronic address: giovanni.pratesi@unige.it.
¹⁰ Clinica La Sagrada Familia, Buenos Aires, Argentina. Electronic address: luis.mariano.ferreira@gmail.com.
¹¹ Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, and Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, The Netherlands. Electronic address: j.p.p.m.de.vries@umcg.nl.
¹² Bedfordshire - Milton Keynes Vascular Centre, Bedfordshire Hospitals Foundation Trust, Bedford, UK. Electronic address: a.chaudhuri@ntlworld.com.
¹³ Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands, and Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
¹⁴ Department of Vascular and Endovascular Surgery. Ramón y Cajal´s University Hospital, Madrid, Spain.
¹⁵ Bedfordshire - Milton Keynes Vascular Centre, Bedfordshire Hospitals Foundation Trust, Bedford, UK.
¹⁶ a)Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, b)IRCCS Ospedale Policlinico San Martino, Genoa.
¹⁷ Clinica La Sagrada Familia, Buenos Aires, Argentina.
¹⁸ Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, Városmajor U. 68., Budapest, 1122, Hungary.

PMID: 38579908
DOI: 10.1016/j.avsg.2024.01.002

Abstract

Introduction: The study aims to describe midterm outcomes following treatment of infrarenal abdominal aortic aneurysms (AAAs) with short necks by endosutured aneurysm repair (ESAR) using the Heli-FX EndoAnchor system.

Methods: This is a retrospective study of prospectively collected data from nine vascular surgery departments between June 2010 - December 2019, including treated AAAs with neck lengths ≤ 10mm. The decision for the use of EndoAnchors was made by the treating surgeon or multidisciplinary aortic committee according to each centre's practice. There were two subgroups further assessed according to neck length, A (≥4 and < 7mm) and B (≥7 and ≤10mm). The main outcomes analysed were technical success, freedom from type Ia endoleaks (TIaEL), sac size increase, all-cause (ACM) and aneurysm related mortality (ARM).

Results: 76 patients were included in the study, 17 fell into Subgroup A and 59 into subgroup B. Median follow-up for the cohort was 40.5 (IQR 12-61) months. A median of 6 (IQR 3) EndoAnchors were deployed in each subject. Technical success was 86.8% for the total group, 82.4% and 88.1% (p=0.534) for subgroups A and B respectively. Six out of ten (60%) of TIaELs at the completion angiographies showed spontaneous resolution. Cumulative freedom from TIaEL at 3 and 5 years for the total group was 89% and 84% respectively; this was 93% and 74% for subgroup A and 88% at both intervals in subgroup B (p=0.545). In total, there were 7 (9.2%) patients presenting with type Ia endoleaks over the entire study period. Two (11.8%) in subgroup A and 5 (8.5%) in subgroup B (p=0.679). There were more patients with sac regression in subgroup B (subgroup A=6 - 35.3% versus subgroup B=34 - 57.6%, p=0.230) with no statistical significance. ACM was 19 (25%) patients, with no difference (4 - 23.5% versus 15 - 25.4%, p=0.874) between subgroups; whereas ARM occurred in one patient from subgroup A and 3 from subgroup B.

Conclusions: This study demonstrates reasonable outcomes for patients with short-necked AAAs treated by ESAR in terms of type Ia endoleaks up to 5 year follow up. EndoAnchor use should be judiciously evaluated in short necks and may be a reasonable option when anatomical constraints are encountered, mainly for those with 7-10mm neck lengths. Shorter neck length aspects, as indicated by the results from Group A, may be an alternative when no other options are available or feasible.

Keywords: ESAR; EVAR; EndoAnchors; short neck; type IaEL.