A New Tool in the TEVAR Toolbox: Focal Endovascular Aortic Repair Using Endoanchors
Corbin Muetterties, Bill Moser, Yoshi Toyoda, Sloane Guy, Larry Kaiser, Grayson H. Wheatley, III.
Temple University School of Medicine, Philadelphia, PA, USA.
OBJECTIVE: Aortic stent-grafts are being used to treat increasingly complex aortic pathologies. As a result, the type I endoleak rate is 4-6% due to poor stent-graft apposition in patients with short or excessively angulated landing zones. A novel endovascular technology has been developed to focally treat endoleaks in the infra-renal abdominal aorta which augments attachment of the aortic stent-graft using endoanchors. We reviewed our experience with endoanchors in thoracic endovascular aortic repair (TEVAR) procedures and performed a comprehensive review of the literature.
METHODS: We reviewed our institutional aortic database for endoanchor use in TEVAR procedures from October 2013 to present. In addition, we performed a PubMed query for peer-reviewed publications using the search terms “endoanchors” or “endostapler”. We recorded the type of aortic disease being treated, type of endoleak, location of the aortic pathology and outcome.
RESULTS: Three TEVAR patients were treated with endoanchors; 1 for treatment of a type Ia endoleak and 2 for prophylactic augmentation of the seal zone. Two interventions were in the aortic arch (Figure 1) and 1 was in the supra-celiac aorta. The type Ia endoleak resolved following deployment. There were no strokes, incidences of paraplegia or deaths. Mean follow-up of 4 months demonstrated no endoleaks or stent-graft migrations. The PubMed review demonstrated 11 publications pertaining to endoanchors, with 1 publication pertaining to TEVAR. A total of 6 patients were treated, with all interventions being for type Ia endoleaks. Four patients were treated in the aortic arch and 2 in the supra-celiac aorta. All 6 patients had resolution of their endoleak. One patient expired 4 weeks post-op from visceral and cerebral infarctions. At a mean follow-up of 11 months, no stent-graph migration or endoleaks were observed.
CONCLUSIONS: Endoanchors are a viable treatment option for addressing type I endoleaks associated with TEVAR procedures, potentially avoiding additional stent-graft deployment or coverage of branch vessels. Additional follow-up is needed to understand the role of endoanchors in prophylactically preventing stent-graft migration in hostile landing zones.
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