Vascular Endostapling: New Concept for Endovascular Fixation of Aortic Stent-Grafts

Purpose: To evaluate the feasibility of a new vascular endostapling system in treating infrarenal abdominal aortic aneurysms using commercially available endografts. Methods: Eight patients (6 men; mean age 71 years, range 59-82) underwent endovascular aneurysm repair (EVAR) using Talent or Zenith stent-grafts and the Anson Refix clip, which provides transmural aortic fixation of the endoprosthesis with high pullout force proportional to the number of the clips deployed. Results: Twenty (69%) of the 29 endostaples were successfully implanted and secured with the endostaple system; 9 clips that did not fully penetrate the graft and tissue due to severe calcification of the neck were retracted successfully into the delivery device. The delivery time from insertion of the Refix delivery catheter to its withdrawal was a mean 57 minutes (range 20-102) over and above the regular stent-graft procedure. Notably, the delivery time was reduced as the learning curve was passed: mean 89.75 minutes in the first 4 cases versus 27.5 minutes in the last 4. No endostaple migrated or was lost from the intended deployment site based on radiological imaging. No patients had evidence of perioperative endoleak based on computed tomography. No endograft-related complications have been documented during follow-up at 30 days. Conclusion: The initial experience established the safety and feasibility of EVAR using the Anson Refix endostapling system. However, further clinical evaluation is mandatory to draw robust conclusions about the utility of this new concept for fixation of aortic stent-grafts.