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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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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.