Endoanchoring systems in endovascular aortic aneurysm repair

Evidence-based recommendations on endoanchoring systems in endovascular aortic aneurysm repair. This involves using an anchoring device to hold a stent in place to prevent leaks in an aneurysm repair.

# Recommendations
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.# The condition, current treatments and procedure

# The condition
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).

# Current treatments
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 stentgraft is deployed under X-ray guidance and positioned across the aneurysm.
In endovascular aortic aneurysm repair (EVAR) procedures, the stentgraft can sometimes leak (endoleak) or move out of place (migrate), or a person'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.

# The procedure
Endoanchoring systems aim to improve the fixation of the stentgraft 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.
Endoanchoring implants are inserted under general or local anaesthesia. The implants are deployed through an applier device consisting of a catheter and a control handle. The catheter is advanced until the distal end contacts the stentgraft and vessel wall. The number of implants needed depends on the type of stentgraft and the size of the native vessel. They are placed as evenly as possible around the circumference of the stentgraft. The catheter is then removed, the holes in the femoral arteries are sutured and the groin wounds are closed.