title: Midterm outcome of EndoAnchors for the prevention of endoleak and stent-graft migration in patients with challenging proximal aortic neck anatomy.
abstract: OBJECTIVE
  To explore the use of EndoAnchors as an adjunct to endovascular abdominal aortic aneurysm repair for prevention of proximal neck complications in patients with challenging neck anatomy.
  
  
  METHODS
  Over a 28-month period, 208 patients (159 men; mean age 72±8 years) were enrolled in the ANCHOR prospective, multicenter registry (ClinicalTrials.gov; identifier NCT01534819) for prophylaxis against proximal neck complications. Patients were eligible when, in the opinion of the investigators, they were at increased risk for type Ia endoleak or migration owing to a hostile neck (length <10 mm, diameter >28 mm, angulation >60°, mural thrombus or calcium >2 mm in thickness or >180° in circumference, or conical shape). Overall, 123/157 (78.3%) patients met the criteria for a hostile neck according to core laboratory assessment of 157 adequate preoperative computed tomographic (CT) images.
  
  
  RESULTS
  Implantation of EndoAnchors was technically successful in 204/208 (98.1%) patients. The frequency of fracture was 0.3% (3/1118); there were no clinical sequelae associated with the fractures. Over the mean 14-month follow-up, 95.2% of patients were alive, and no deaths were attributable to EndoAnchors. There were no ruptures, migrations, or open surgical conversions. Aneurysm-related reinterventions were performed in 8 (3.8%) patients. Among 130 patients with postprocedure contrast CT studies, core laboratory analysis identified 2 (1.5%) patients with type Ia endoleaks. Aneurysm sac diameter decreased >5 mm in 42.9% of patients with CT scans at or beyond 1 year; 1.6% of patients developed sac enlargement >5 mm.
  
  
  CONCLUSIONS
  Prophylactic EndoAnchor use for challenging aortic neck anatomy was associated with satisfactory midterm results.
authors: University of Alabama-Birmingham, Birmingham, AL, USA wjordan@uabmc.edu.
authors: William D
authors: WD
authors: Jordan
authors: St. Antonius Hospital, Nieuwegein, the Netherlands.
authors: Jean-Paul P M
authors: JP
authors: de Vries
authors: Syntactx, LLC, New York, NY, USA.
authors: Kenneth
authors: K
authors: Ouriel
authors: Vascular Group, PLLC, Albany, NY, USA.
authors: Manish
authors: M
authors: Mehta
authors: Vascular Institute of Central Florida, Orlando, FL, USA.
authors: David
authors: D
authors: Varnagy
authors: Lexington Medical Center, Lexington, SC, USA.
authors: William M
authors: WM
authors: Moore
authors: Carolinas Medical Center, Charlotte, NC, USA.
authors: Frank R
authors: FR
authors: Arko
authors: El Camino Hospital, Mountain View, CA, USA.
authors: James
authors: J
authors: Joye
authors: Mission Hospital, Asheville, NC, USA.
authors: John
authors: J
authors: Henretta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D057867:Endoleak / Q000209:etiology / Q000517:prevention & control*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: EndoAnchor; abdominal aortic aneurysm; angulated neck; angulation; aortic neck; calcification; conical neck; endovascular aneurysm repair; hostile neck; migration; morphology; mural thrombus; short neck; stent-graft; type I endoleak