William D. Jordan, MD, is a principal investigator in the ANCHOR prospective, multicenter registry, which seeks to evaluate Heli-FX EndoAnchors (Aptus Endosystems) for the prevention of endoleak and stent-graft migration in patients with challenging proximal aortic neck anatomy. He presented data from the study at the 2015 VEITH Symposium. Vascular Disease Management spoke with Dr. Jordan about the device and data from the registry. 

VDM: Please introduce yourself and describe the information you’re sharing at the VEITH meeting.

Jordan: I’m a vascular surgeon currently at the University of Alabama - Birmingham, soon to move to Emory University. I’ll be talking about Heli-FX EndoAnchors and their utilization to improve long-term durability for aortic endografts. We use them to treat primary problems, such as endoleaks, and we also use them in patients who are at risk of having late graft failure, whether it be continued aortic dilatation around the proximal aortic neck or related to specific problems at the aortic neck, such as thrombus, calcium, or simply an endoleak that we can identify at the initial implantation. 

VDM: Can you share some data points from the ANCHOR registry?

Jordan: We are constantly gathering information and gathering patients. Now we have over 600 patients in the registry. We do various data cuts as we get the CT scans and get imaging from different sites around the country and around the world, with both United States and European sites participating. What we find is that particularly in some of these challenging necks, short necks, they can be treated with an EndoAnchor in addition to a regular endograft. We can improve the security. We are actually treating type 1 endoleaks in the acute setting, with a 90% success rate.^1-3 We’re also trying to identify longer term stability of the endograft in various subgroups (if the patients have bad necks, maybe large necks, angulated necks, short necks). Currently, the data are looking quite promising, but we still need to gather more information.

VDM: How about in your own personal experience? Have you noticed anything surprising about use of the EndoAnchor?

Jordan: The EndoAnchor adds another toolbox to the armamentarium of the vascular surgeon. We have the ability to manipulate the endograft when it’s very close to the renal arteries and pin it precisely in a secure location against the aortic wall. I found that on some complex cases with snorkel grafts and chimney grafts that I can then secure the main body graft next to the snorkel and potentially improve gutter leaks. Even in these circumstances, it does have good utility. 

VDM: When might you choose not to use an EndoAnchor?

Jordan: If I have a perfectly normal infrarenal neck and everything is secure, I wouldn’t add it because I wouldn’t want to add to the cost of the procedure. However, I still wonder, if we were to secure with the anchor, if it might help reduce the long-term surveillance need. I see patients 5 to 10 years out after endovascular aneurysm repair that do have late failure. Perhaps this extra measure of security would have prevented this late failure. 

VDM: What do you think the most important takeaway will be from your presentation for vascular clinicians?

Jordan: I’m presenting specifically at this conference about the prevention of late failure – prophylactic use. The takeaway message is to think about it for short-neck aneurysms and a large diameter proximal neck. For patients who have a proximal neck of more than 27 mm, and you’re placing a 30 mm endograft or larger, most patients already have a baseline dilatation of the pararenal aorta. This is a circumstance where putting endoanchors in may give us the extra security for the long term. That’s the real take-home message. 

VDM: Anything else you’d like to add?

Jordan: EndoAnchors are pretty easy to use. They add 10-15 minutes to your procedure once you get familiar with it and it’s another power tool to have available. So think about it when you have a challenging neck.  

Editor’s note: William D. Jordan, MD, is Professor and Chief of the Division of Vascular Surgery and Endovascular Therapy at Emory University Hospital in Atlanta, Georgia. He reports grants, honoraria, payment for educational material, and reimbursements from University of Alabama – Birmingham.

References

1. Jordan WD Jr, de Vries JP, Ouriel K, et al. Midterm outcome of EndoAnchors for the prevention of endoleak and stent-graft migration in patients with challenging proximal aortic neck anatomy. J Endovasc Ther. 2015;22(2):163-170. 
2. Jordan WD Jr, Ouriel K, Mehta M, et al; Aneurysm treatment using the Heli-FX Aortic Securement System global registry ANCHOR; aneurysm treatment using the Heli-FX Aortic Securement System global registry ANCHOR. Outcome-based anatomic criteria for defining the hostile aortic neck. J Vasc Surg. 2015;61(6):1383-1390. 
3. de Vries JP, Ouriel K, Mehta M, et al; Aneurysm Treatment Using the Heli-FX Aortic Securement System Global Registry ANCHOR Trial. Analysis of EndoAnchors for endovascular aneurysm repair by indications for use. J Vasc Surg. 2014 Dec;60(6):1460-