Interventional procedure overview of endoanchoring systems in endovascular aortic aneurysm repair

Indications and current treatment

Aortic aneurysms develop when the wall of the aorta weakens, causing it to bulge and form a balloon-like expansion. They can happen in the chest (thoracic aortic aneurysms) or, more commonly, below the diaphragm (abdominal aortic aneurysms).

The standard treatment for aortic aneurysm is either open surgical or endovascular repair. During open surgical repair the aneurysm is opened and a graft is sewn in above and below the weakened area to allow normal blood flow. Endovascular repair is a minimally invasive alternative to open repair. A graft is mounted on a stent, which is inserted into the aorta through catheters placed in the femoral arteries. The stent–graft is deployed under X‑ray guidance and positioned across the aneurysm.

In EVAR procedures, the stent–graft can sometimes leak (endoleak) or move out of place (migrate), or a patient's anatomy can make its placement difficult. Type 1 endoleaks happen around the top or bottom of grafts and are often caused by an inadequate seal. Type 1 endoleaks are subdivided into 3 further categories: 1a – proximal, 1b – distal and 1c – iliac occluder.

What the procedure involves

Endoanchoring systems aim to improve the fixation of the stent–graft used in EVAR. They may be used prophylactically or therapeutically at the same time as the primary procedure or during a later, secondary procedure to treat an endoleak or migration.

Endovascular aortic aneurysm repair can be done under general, regional or local anaesthesia. A catheter is inserted through a small incision in the femoral artery and directed to the aortic aneurysm. Contrast is injected into the catheter and X-rays are used to monitor the procedure. A stent–graft is passed through the catheter, advanced to the aneurysm and then opened, creating new walls in the blood vessel. When the stent–graft is deployed it seals the aneurysm. Anchoring implants can then be deployed through an applier device that consists of a catheter and a control handle. The catheter is advanced until the distal end contacts the stent–graft and vessel wall. The number of implants needed depends on the type of stent–graft and size of the native vessel. They are placed as evenly as possible around the circumference of the stent–graft. The catheter is then removed, the holes in the femoral arteries are sutured and the groin wounds closed.