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EndoSuture Aneurysm Repair (ESAR)

ESAR offers a durable, reinforced seal and protects against neck dilatation to minimize Type Ia endoleaks.1-3
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Alert Indications, Safety, and Warnings

Today, EVAR is an effective and efficient treatment for abdominal aortic aneurysm.

However, there are certain endovascular aneurysm repair (EVAR) patients who are at greater risk for neck dilatation and/or loss of proximal seal, leading to worse outcomes.

Key Factors that Put an EVAR Patient at Risk for Suboptimal Outcomes4

Hostile Necks

Retrospective analysis of 552 elective EVARs5

  • 4.5X increased risk of Type la endoleak (P = 0.01)5
  • 10X increased risk of aneurysm-related mortality (P = 0.01)5

Wide Necks

Meta-analysis6 of neck diameters ≥ 25, ≥ 28, and ≥ 30 mm

  • 6.7X more likely to have Type la endoleak (P = 0.001)6
  • 10X more likely to have sac expansion (P = 0.009)6
Short aortic neck illustration

Short

Wide aortic neck illustration

Wide

Angulated aortic neck illustration

Angulated

Conical aortic neck illustration

Conical

Additional Considerations

Long Life Expectancy

AAA is a progressive dilating disease even after EVAR or open surgical repair.7

Follow-up Challenges

22% of EVAR patients were lost to imaging follow-up at 1 year.8 Independent risk factors for not following up:

  • Urgent or emergent cases8
  • Multiple comorbidities8
  • Older patients8
  • Travel time to hospital9

What are the Challenges after EVAR in Wide Necks?

Neck Dilatation

Neck diameter is an independent risk factor for neck dilatation.10 Diameters ≥ 25 mm have greater risk of dilatation after EVAR
(p = 0.02).11

Type Ia Endoleaks

Wide necks are more likely to develop Type Ia endoleaks (p = 0.049),12 which transmit the highest pressures into the sac.13

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.

ESAR in Wide Necks

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

Call in the Reinforcements

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

  • Reinforce the proximal seal1,14
  • Protect against neck dilatation15
  • Minimize Type la endoleaks2
  • Promote greater sac regression16

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References

1

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):1726-33.

2

ANCHOR 4-year primary arm. 2019 data cut. Medtronic data on file.

3

Chaudhuri A, Kim HK, Valdivia AR. Improved Midterm Outcomes Using Standard Devices and EndoAnchors for Endovascular Repair of Abdominal Aortic Aneurysms with Hyperangulated Necks [published online ahead of print, 2020May 8]. Cardiovasc Intervent Radiol. 2020;10.1007/s00270-020-02488-4.

4

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. 

5

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):527-38.

6

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.

7

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):929-34. 

8

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.

9

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.

10

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.

11

Cao P, Verzini F, Parlani G, et al. Predictive factors and clinical consequences of proximal aortic neck dilatation in 230 patients undergoing abdominal aorta aneurysm repair with self-expandable stent-grafts. June 2003; 37(6):1200-5.

12

Oliviera NFG, Golcalves FB, Ultee K, et al. Patients with large neck diameter have a higher risk of type 1A endoleaks and aneurysm rupture after standard endovascular aneurysm repair. J Vasc Surg. March 2019;69(3)783-791.

13

Li J, Tian X, Wang Z, et al. Influence of endoleak positions on the pressure shielding ability of stent-graft after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). Biomed Eng Online. 2016;15(Suppl 2): 135.

14

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.

15

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. July 2017;66(1):45-52.

16

Muhs BE, Jordan W, Ouriel K, et al. Matched cohort comparison of endovascular abdominal aortic aneurysm repair with and without EndoAnchors. J Vasc Surg. June 2018;67(6):1699-1707.