Endoanchoring systems in endovascular aortic aneurysm repair

For people with unfavourable aneurysm morphology needing an endovascular aortic aneurysm repair (EVAR) as a primary procedure, or for people with an existing EVAR who need a secondary procedure, evidence on the safety of using endoanchoring systems is adequate. Evidence on efficacy is limited in quantity and quality. Therefore, for these people, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

For people with favourable aneurysm morphology needing an EVAR as a primary procedure, evidence on the safety of using endoanchoring systems is adequate. However, evidence on efficacy is inadequate in quantity and quality. Therefore, for these people, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.

Clinicians wanting to use endoanchoring systems for people with unfavourable aneurysm morphology needing an EVAR as a primary procedure, or for people with an existing EVAR who need a secondary procedure should:

• Inform the clinical governance leads in their healthcare organisation.

• Give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public.

• Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.

• Enter details about everyone having endoanchoring systems in endovascular aortic aneurysm repair into the National Vascular Registry and review local clinical outcomes.

• Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.

Healthcare organisations should:

• Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure.

• Regularly review data on outcomes and safety for this procedure.

Patient selection should be done by a multidisciplinary team.

Further research should report details of patient selection and include longer-term outcomes.