Assessment of a new type I endoleak repair technique using an anchoring device.

Abstract

OBJECTIVE: Type I endoleaks are one of the most frequent and life-threatening complications of thoracic endovascular aortic repair. This study aimed to assess the use of suture-anchoring devices for repairing type I endoleaks. METHODS: The descending aortic aneurysm model (saccular type) was made by side-to-end anastomosis to a Dacron graft. A Matsui-Kitamura stent graft was deployed to create a proximal type I endoleak. Approximately 5 mm above the upper rim of the anastomosis, the aorta was punctured by the pistol of the suture-anchoring device with a T-shaped bar under fluoroscopy. Sutures were applied until angiography showed the absence of a type I endoleak. During the process, two pressure measurements were used to perform continuous assessments of aortic pressure and intra-aneurysm sac pressure. RESULTS: A mean &#xb1; SD of 5 &#xb1; 1 anchoring shots were used to eliminate type I endoleaks. The device performed well, and no complications were observed. The mean &#xb1; SD intrasac pressures before stent graft deployment, during endoleak maintenance, and after repair were 118 &#xb1; 5, 61 &#xb1; 4, and 26 &#xb1; 5 mm Hg, respectively. The postrepair pressure was significantly decreased (P < 0.001; Student t test). CONCLUSIONS: Despite some anatomic and clinical limitations identified during the experiments, the effectiveness of the suture-anchoring device was confirmed. Further improvement of the device will soon lead to its use as a less invasive endoleak repair procedure.