A Wider Grip: Endoanchors Increase Proximal Sealing Surface during Endovascular Aneurysm Repair

Aim: To evaluate how the Heli-FX EndoAnchor system (Medtronic Vascular, Santa Rosa, CA, USA) influences the Real Achieved Sealing Zone (RASZ) compared to EVAR with Endurant (Medtronic Vascular, Santa Rosa, CA, USA) alone in a matched and unmatched real-world cohort METHODS: In a retrospective, single-center study (2015-2022), 221 AAA patients underwent Endurant stent graft (Medtronic Vascular, Santa Rosa, CA, USA) placement either alone (n=190) or with adjunctive Heli-FX EndoAnchors (n=31). Pre- and postoperative computed tomography angiography (CTA) scans were evaluated using a standardized measurement technique (closed-polygon area, center lumen line distances) to quantify the Target Anticipated Sealing Zone (TASZ) and the Real Achieved Sealing Zone (RASZ). Primary endpoints were changes in RASZ length and area compared to TASZ. Secondary endpoints included type 1A and any endoleak rates, overall reinterventions. Statistical analysis included unadjusted and adjusted Cox proportional hazard regression models, receiver operating characteristic (ROC) curves, and propensity score matching. Results: Heli-FX patients presented significantly more "hostile" proximal sealing zones, featuring shorter TASZ length (11 vs. 17 mm; p=0.003), higher infrarenal angulation (45° vs. 18°; p<0.001). Despite this hostile anatomy, the Heli-FX group exhibited a substantial increase in RASZ area (+48.3 mm2; p=0.001) and length (+5.8 mm; p=0.003) compared to standard EVAR patients. ROC analysis indicated distinct RASZ cutoffs for predicting type 1A endoleak in each group (27.7 mm2 and 4.5mm for Heli-FX vs. 49.5 mm2 and 9.5mm for Endurant). In the 24 TASZ-features-matched couples, Heli-FX patients showed increased RASZ area (+42 vs -31 mm2 over TASZ; p=0.003), and length (+5 vs -3mm over TASZ; p=0.003). Conclusions: EndoAnchors substantially improve RASZ length and surface area compared to EVAR with the same stent graft alone. Routine device-specific RASZ assessment could refine treatment algorithms and pave the way for more personalized and durable endovascular solutions.