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.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).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.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.
