title: Primary endoanchoring in the endovascular repair of abdominal aortic aneurysms with an unfavorable neck.
abstract: OBJECTIVE
  To investigate the feasibility and early results of endoanchoring (endostapling) using a new commercially available device as an adjunctive procedure during endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) with an unfavorable proximal neck.
  
  
  METHODS
  Between June 2010 and May 2012, 13 consecutive patients (all men; median age 73 years, range 62-82) were prospectively enrolled in a 2-center registry to follow outcomes of adjunctive primary endoanchoring (Aptus HeliFX Aortic Securement System) of the proximal endograft to enhance proximal graft fixation and sealing during EVAR. Indications for proximal neck endoanchoring included at least one of the following: neck angulation 45° to 90°, length 8 to 15 mm, diameter 29 to 33 mm, conical neck configuration, or an irregularly shaped neck. The median AAA diameter was 56 mm (range 50-98). The Endurant stent-graft was implanted in 4 patients and the Zenith device in 9.
  
  
  RESULTS
  A median of 4 endoanchors were implanted per patient (range 3-10) in adjunctive procedures that required a median 12 minutes (range 7-20). Intraoperatively, 2 proximal type I endoleaks were present following endoanchor implantation (85% primary technical success); a cuff was deployed in 1 case, which successfully sealed the endoleak (92% assisted primary technical success). The second proximal type I endoleak was minute and sealed spontaneously within 30 days. No further major device-related complications occurred intraoperatively. In the 30-day perioperative period, the only procedure-related complications were 2 type II endoleaks, which required no intervention. Over a median follow-up of 7 months (range 2-17), no further complications occurred apart from an asymptomatic internal iliac artery occlusion and a non-lethal myocardial infarction at 9 months. The type II endoleaks spontaneously sealed. No endograft migration was noticed nor loss of endoanchor integrity. No deaths occurred throughout follow-up.
  
  
  CONCLUSIONS
  Primary endoanchoring using the HeliFX aortic securement system is feasible, and early results were promising in this series.
authors.affiliation: Department of Vascular Surgery, Hellenic Air Force Hospital, Athens, Greece.
authors.forename: Theodosios
authors.initials: T
authors.lastname: Perdikides
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Melas
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Lagios
authors.forename: Athanasios
authors.initials: A
authors.lastname: Saratzis
authors.forename: Athanasios
authors.initials: A
authors.lastname: Siafakas
authors.forename: Ioannis
authors.initials: I
authors.lastname: Bountouris
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kouris
authors.forename: Murat
authors.initials: M
authors.lastname: Avci
authors.forename: Danyel A F
authors.initials: DA
authors.lastname: Van den Heuvel
authors.forename: Jean-Paul P M
authors.initials: JP
authors.lastname: de Vries
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D015607:Stents; D017792:Surgical Stapling / Q000009:adverse effects / Q000295:instrumentation; D013537:Sutures; D013997:Time Factors; D016896:Treatment Outcome