The advantages of Anaconda endograft for AAA.

AIM: The Anaconda endograft (Vascutek, Terumo, Inchinnan, Scotland) is an infrarenal, trimodular stent-graft with peculiar characteristics in terms of implant, proximal sealing and fixation of the main body and iliac legs. This endograft can be used in infrarenal abdominal aortic aneurysm (AAA) with an aortic neck >or=15 mm in length. The authors evaluated the mid-term outcome of the Anaconda endograft in the treatment of infrarenal AAA also in cases with tortuous anatomy.

METHODS: Between September 2005 and September 2008, 100 patients (94 males, 6 females) with mean age of 73.9+/-5.2 years (range 55-89) were considered eligible for treatment with Anaconda endograft (proximal neck length >or=15 mm). The mean aneurysm size was 55.2+/-3.4mm (range 45-99 mm). An angulation of the aortic neck greater than 60 degrees was present in 19 cases. The iliac arteries were severely angulated >60 degrees in 61 patients. The mean follow-up was 23.2+/-11.0 months (range 1.4-38.6).

RESULTS: Primary technical success was achieved in 100% of the patients. Six patients died during follow-up, none for aneurysm-related causes. Survival rate was 87.9% at 24 months of follow-up. Primary and assisted clinical success were respectively 80.8% and 93.7% at 24 months with a freedom from reintervention of 88.8%. No cases of endograft migration were observed and only one case of type I proximal endoleak was recorded in the mid-term follow-up. The univariate and the multivariate analysis did not show an increased risk in patients with angulated proximal neck or iliac arteries.

CONCLUSIONS: As evidenced in this clinical study, the mid-term outcomes of Anaconda endograft are satisfactory concerning the treatment of AAA with a minimum neck length of 15 mm. This device proved in the mid-term to effectively protect the patient treated from aneurysm rupture. Presence of even severe tortuosity of the proximal neck and of the iliac arteries did not affect outcomes. Considering these results showing the safety of Anaconda endograft, the authors suggest its employment also in cases with difficult anatomy.