Vaskulárna medicína 2/2024
Treatment of periprocedural type Ia endoleak in EVAR patients with complex proximal neck anatomy using the Heli-FX anchoring system
Purpose: Despite the hostile neck anatomy and associated higher risk of periprocedural complications, standard endovascular aortic aneurysm repair (EVAR) sometimes remain the only treatment option for these patients. The aim of this study is to highlight the possibilities of endovascular treatment of periprocedural type Ia endoleak in patients with complex anatomy using the Heli-FX EndoAnchors system. Methodology: In the period from November 2018 to October 2021, we identified a total of 10 patients (8 men, 2 women) with abdominal aortic aneurysm with complex proximal neck anatomy, in whom periprocedural type Ia endoleak was angiographically confirmed. The average age of the patients was 76 years (63-91). We defined complex anatomy as the occurrence of at least one of the following parameters: neck length ≤ 15 mm, diameter ≥ 28 mm, angulation ≥ 60°, conical morphology of the neck and the presence of mural thrombus or calcifications on more than 50% of the circumference of the anchorage zone. Nine patients participated in the follow-up. The mean follow-up period in 9 patients was 30 months, median 36 months (IQR 12 - 43.5). Results: Technical and procedural success rate was 100%. There were no EndoAnchor fractures, dislocations, or stent graft fabric damage due to anchor implants. In one patient, implantation of an aortic extension cuff was necessary before implanting the EndoAnchors because of the distal displacement of the endograft. In one patient, postprocedural type Ia endoleak was observed on control CTA, with its spontaneous disappearance after one month. During follow-up, we did not observe the development of a late type Ia endoleak, stent graft migration, or AAA sac rupture in any of the patients. Conclusion: The Heli-FX EndoAnchor system is an effective method for treating periprocedural type Ia endoleaks in AAA patients with complex proximal neck anatomy, with good short—and medium-term results.
Keywords: endovascular treatment, abdominal aortic aneurysm, proximal neck, endoleak, Heli-FX EndoAnchor system
