# Midterm Aortic Neck Evolution after EndoSuture Aneurysm Repair: a Single Centre Retrospective Analysis

## TL;DR

This study shows that EndoSuture aneurysm repair is a safe and effective option for patients with difficult aortic neck anatomy, preventing complications over three years.

## Contribution

This is the first study to report 36 months of aortic neck evolution data after ESAR, demonstrating its midterm safety and efficacy.

## Key findings

- No aortic neck dilation or type 1 endoleak was observed over three years.
- ESAR was feasible and safe in patients unsuitable for open surgery or fenestrated endovascular repair.
- Overall survival at three years was 74% with no procedure-related deaths.

## Abstract

Long term results from large international registries have shown satisfactory results in terms of type 1 endoleak (EL1a) prevention and sac shrinkage using EndoSuture aneurysm repair (ESAR) in patients with a hostile aortic neck; however, little is known about the midterm behaviour of the aortic neck after ESAR.

This study retrospectively analysed the aortic neck evolution and overall results of ESAR procedures performed at this institution between September 2017 and August 2020. Patients with a hostile aortic neck, and or who were unfit for elective open repair, and or presented with abdominal aortic target vessel or iliac anatomy unsuitable for a fenestrated endograft (FEVAR), and or for whom there was insufficient time for FEVAR manufacturing were included.

Twenty-three patients were included (male 22/23, 96%; median age 75 years, range 58–87 years), and were followed up for 36.5 ± 16.3 months. Technical and procedural success rates were 100% and 96%, respectively. No aortic rupture or dissection was encountered peri-operatively and no displacement, migration, or unachieved penetration of the EndoAnchors was observed. The median operating time was 145 (range 87–236) minutes. No aortic neck dilation was observed at six, 12, 24, and 36 months. There was no persistent or new EL1a or limb occlusion. The 30 day and one year mortality rate was 0%. Six non-aneurysm related deaths were observed during follow up (26%). The overall survival at one, two, and three years was 100%, 100%, and 74%, respectively.

This analysis of aortic neck evolution three years after ESAR suggests that EndoAnchors may help prevent aortic neck and suprarenal aortic dilatation in the midterm, without re-interventions for type EL1a. ESAR is a feasible procedure in patients with hostile aortic neck, and/or who are unfit for open surgery, and/or in whom anatomical or technical constraints prevent the use of FEVAR.

•Despite mounting evidence and five years of follow up data coming from international registries, EndoSuture aneurysm repair (ESAR) has failed to gain popularity in vascular practice.•This study is the first to report 36 months of data on aortic neck evolution after ESAR.•It found that this is a feasible and safe procedure, valuable in patients with hostile neck, and or unfit for open surgical repair and or with technical constraints for fenestrated endovascular repair.

Despite mounting evidence and five years of follow up data coming from international registries, EndoSuture aneurysm repair (ESAR) has failed to gain popularity in vascular practice.

This study is the first to report 36 months of data on aortic neck evolution after ESAR.

It found that this is a feasible and safe procedure, valuable in patients with hostile neck, and or unfit for open surgical repair and or with technical constraints for fenestrated endovascular repair.