EndoAnchors Use With Infrarenal vs. Suprarenal Stent Grafts-Results from ANCHOR Global Registry
Apostolos K. Tassipoulos, MD1, Manish Mehta, MD, MPH2, William Jordan, MD3, Philip Paty, MD2, Kenneth Ouriel, MD4.
1Stony Brook Medicine, 2Vascular Health Partners, Queensbury, NY, USA, 3Emory Healthcare, Atlanta, GA, USA, 4Syntactx, New York City, NY, USA.
Objective: EndoAnchors have shown safety and efficacy in maintaining proximal seal and in treatment of Type I endoleaks. The ANCHOR Global Registry data captured use of a variety of endografts with infrarenal (IR) and suprarenal (SR) fixation; approximately 75% of patients were considered to have ≥1 marker for hostile aortic neck anatomy. The outcomes of the EndoAnchor EVAR with IR and SR stent grafts were analyzed.
Methods: A propensity analysis was performed to compare the results of 254 subjects treated with EndoAnchors plus infrarenal EVAR (IR-EVAR, n=127) vs. those subjects that were treated with a EndoAnchors plus suprarenal EVAR (SR-EVAR, n=127). An independent core lab performed a propensity matched analysis of 24 anatomic/ physiologic/ geographic factors in all patients.. EndoAnchors were utilized at the time of Primary IR-EVAR (83.5%, 106/127), Primary SR-EVAR (89.0%, 113/127, P=.27), delayed Revision IR-EVAR (16.5%, 21/127), and delayed Revision SR-EVAR (11.0%, 14/127).
Results: When comparing the EndoAnchor plus IR-EVAR vs. EndoAnchor plus SR-EVAR groups, there were no statistically significant differences in mean age (76.4 vs. 76.1 yrs, p=.76), gender (male: 75.6% vs. 78.0%, p=.77), mean AAA diameter (57.1±15.1 vs 57.3±12.0 mm, P=.94), proximal neck length (19.6±13.5 vs. 18.5±13.2 mm, P=.64), or infrarenal neck angulation (37±19 vs. 36±19 degrees, P=.86).
Furthermore, when comparing the EndoAnchor plus IR-EVAR vs EndoAnchor plus SR-EVAR groups, there was no difference in the incidence of Type 1a endoleak (6.3%, 6/96 vs. 5.2%, 5/91, P=0.99), AAA sac regression >5mm (34.7%, 35/101 vs. 32.9%, 27/82, P=0.88), or AAA sac enlargement >5mm (3.0%, 3/101 vs. 1.2%, 1/82, P=0.63).
In Primary cases (mean follow-up 21.2±9.3 months), aneurysm-related reinterventions were similar in the IR-EVAR group (8.5%, 9/106) and the SR-EVAR group (11.5%, 13/113, P=.51). While aneurysm-related reinterventions were more common in Revision cases (mean follow-up 20.0±10.2 months), there were no differences in the rate in the IR-EVAR group (23.8%, 5/21) vs. the SR-EVAR group (21.4%, 3/14, P=.99).
Conclusions: Propensity matched analysis of the ANCHOR global registry data indicates that at midterm follow-up, primary and delayed secondary use of EndoAnchors with infrarenal and suprarenal stent grafts are equally effective in maintaining a low incidence of Type Ia endoleaks, aneurysm sac regression, and the need for secondary interventions.
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