Aortic endovascular repair | Cardiovascular

EndoSuture aneurysm repair (ESAR)

ESAR mimics a sutured anastomosis to provide durability through reinforcement of the proximal seal in endovascular aneurysm repair (EVAR).1–3

Patients at risk

Today, EVAR is an effective and efficient treatment for abdominal aortic aneurysm (AAA). However, there are certain EVAR patients who are at greater risk for neck dilatation and/or loss of proximal seal, leading to worse outcomes.

Illustration of an abdominal wide neck aneurysm in the abdomen below the heart in pink and blue colors

Key factors for suboptimal outcomes

Hostile necks

  • 4.5X increased risk of Type la endoleak (P = 0.01)
  • 10X increased risk of aneurysm-related mortality (P = 0.01) 

(n = 1,559 follow-up at one year)4

Wide necks*

  • 6.7X more likely to have Type la endoleak (P = 0.001)
  • 10X more likely to have sac expansion (P = 0.009)
  • 5.1X more likely to rupture (P = 0.01)

(n = 6,602 follow-up ranged from 2.7 years [mean] to 3.9 years)5

Short aortic neck illustration


Wide aortic neck illustration


Angulated aortic neck illustration


Conical aortic neck illustration


Additional considerations for abdominal aortic aneurysm (AAA)

Long life expectancy

AAA is a progressive dilating disease even after EVAR or open surgical repair.6

Follow-up challenges

22% of EVAR patients were lost to imaging follow-up at one year.7 Independent risk factors for not following up:

  • Urgent or emergent cases7
  • Multiple comorbidities7
  • Older patients7
  • Travel time to hospital8

ESAR: Reinforced seal, redefined outcomes

ESAR reinforces and protects the proximal seal leading to better outcomes in wide necks.

ANCHOR registry wide neck cohort three-year data (n = 72)9

  • 98.5% three-year freedom from (FF) type la endoleak (1 patient presented with a type la at their 30-day follow-up, self-resolved)
  • 100% three-year FF secondary procedures to treat Type la
  • 100% three-year FF migration
  • 100% three-year FF rupture
  • 91.3% (21/23) sacs regressing/stable at three-year
  • 60.9% (14/23) sac regression at three-year

Hear from Professor Michel Reijnen on the importance of the ANCHOR three-year wide neck data.   

The role of ESAR in wide necks

ESAR in wide necks

Learn from the experts about the clinical utility of ESAR as a solution for wide neck patients.

Neck dilatation

Neck dilatation challenges and EndoAnchor design features: Learn how ESAR with the Heli-FX™ EndoAnchor™ system reinforces the proximal seal and protects against neck dilatation to minimize both transient and persistent Type Ia endoleaks.

ESAR with the Heli-FX EndoAnchor system

Learn about the benefits of ESAR and the key elements of deployment.

Call in the reinforcements.

ESAR with the Heli-FX EndoAnchor system is your defense for patients at risk for suboptimal outcomes.

  • Reinforce the proximal seal1,3
  • Protect against neck dilatation10
  • Minimize Type la endoleaks2
  • Promote greater sac regression11,12

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Wide neck definition varied from ≥ 25 mm to ≥ 31 mm.

Denominator is the number of subjects with maximum aneurysm diameter reported at both the 1-month post implantation measurement and three-year follow-up time points.



Melas N, Perdikides T, Saratzis A, Saratzis N, Kiskinis D, Deaton DH. Helical EndoStaples enhance endograft fixation in an experimental model using human cadaveric aortas. J Vasc Surg. June 2012;55(6):1726–1733.


Jordan WD, Jr. New Developments From The ANCHOR Registry With Over 5 Years Of Follow-Up Show The Value Of Endoanchors When Used Prophylactically For Certain Indications Prevent Endoleaks And Migration: What Are Those Indications. Presented at VEITH symposium 2021.


Schlösser FJV, de Vries JPPM, Chaudhuri A. Is it Time to Insert EndoAnchors into Routine EVAR? Eur J Vasc Endovasc Surg. April 2017;53(4):458–459.


Antoniou GA, Georgiadis GS, Antoniou SA, Kuhan G, Murray D. A meta-analysis of outcomes of endovascular abdominal aortic aneurysm repair in patients with hostile and friendly neck anatomy. J Vasc Surg. February 2013;57(2):527–538.


Kouvelos GN, Antoniou G, Spanos K, Giannoukas A, Matsagkas M. Endovascular aneurysm repair in patients with a wide proximal aortic neck: a systematic review and meta-analysis of comparative studies. J Cardiovasc Surg (Torino). April 2019;60(2):167–174.


Oberhuber A, Buecken M, Hoffmann M, Orend KH, Mühling BM. Comparison of aortic neck dilatation after open and endovascular repair of abdominal aortic aneurysm. J Vasc Surg. April 2012;55(4):929–934.


Schanzer A, Messina LM, Ghosh K, et al. Follow-up compliance after endovascular abdominal aortic aneurysm repair in Medicare beneficiaries. J Vasc Surg. January 2015;61(1):16–22.e1.


Morris AD, Preiss JE, Ogbuchi S, et al. Longer Patient Travel Times Associated with Decreased Follow-Up after Endovascular Aortic Aneurysm Repair (EVAR). Am Surg. August 1, 2017;83(8):e339–341. 


Reijnen M. Podium First: ESAR is more than reinforced proximal seal: three-year ANCHOR study results on wide necks and video technique edited case. Presented at 2022 Charing Cross International Symposium.


Tassiopoulos AK, Monastiriotis S, Jordan WD, Muhs BE, Ouriel K, De Vries JP. Predictors of early aortic neck dilatation after endovascular aneurysm repair with EndoAnchors. J Vasc Surg. 2017;66(1):45–52.


Muhs BE, Jordan W, Ouriel K, Rajaee S, de Vries JP. Matched cohort comparison of endovascular abdominal aortic aneurysm repair with and without EndoAnchors. J Vasc Surg. June 2018;67(6):1699–1707.


Reyes Valdivia A, Oikonomou K, Milner R, et al. The Effect of EndoAnchors on Aneurysm Sac Regression for Patients Treated With Infrarenal Endovascular Repair With Hostile Neck Anatomies: A Propensity Scored Analysis. J Endovasc Ther. Published online October 2022.