Endo-Suture Aneurysm Repair (ESAR) for Complex Short and Tortuous Neck Abdominal Aortic Aneurysm: A Case Report by Professor Yao Chen’s Team
Medtronic
Medical Device Manufacturer
HIGHLIGHTS OF THIS ISSUE
Highlights of This Issue
Introduction /PREFACE
Abdominal aortic aneurysm (including iliac artery aneurysm) is a common disease in vascular surgery. Since the first endovascular aneurysm repair (EVAR) was performed in 1990, this procedure has been widely used in clinical practice due to its minimally invasive, safe, and effective characteristics, gradually becoming the main treatment method for this disease. In order to better promote standardized EVAR diagnosis and treatment, improve clinicians' diagnostic and therapeutic skills, and explore and discuss clinical solutions that are more suitable for patients,【Abdominal Aortic-Iliac Artery Case Showcase】Emerging as the times require.
This column focuses on complex and challenging cases in the field of abdominal aortic diseases, aiming to create a professional platform for case sharing and experience exchange. Here, you can see how surgeons meticulously analyze and develop personalized treatment plans for complex cases, as well as how they skillfully navigate intraoperative challenges to resolve crises. It is hoped that through the case sharing in this column, new ideas and methods for the diagnosis and treatment of abdominal aortic diseases will be provided, jointly promoting advancements in this field and benefiting more patients. This issue will present...Professor Yao Chen's Team from the First Affiliated Hospital of Sun Yat-sen UniversityTheEndostapling Aneurysm Repair (ESAR) for the Treatment of a Tortuous Short-Necked Abdominal Aortic Aneurysm: A Case Report, welcome to read and share.
Basic Information of the Case
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Patient
Male, 76 years old.
Chief Complaint
Abdominal aortic aneurysm discovered during physical examination 1 week ago.
PatientOne week ago, the patient underwent a color Doppler ultrasound examination at another hospital, which showed: suspected abdominal aortic aneurysm with thrombosis formation, without abdominal pain, bloating, or discomfort in the lower back.
Past Medical History
Previous history of coronary heart disease with PCI surgery, long-term smoking.
Case Analysis
Short and twisted neck of the tumor, with anterior arching of the tumor body
Vertical Guidewire Data
(Low renal artery neck 1.5 cm)
In this case, the patient's proximal neck is slightly T-shaped, with a proximal anchoring zone of 17mm and a distal one of 19mm. It is tortuous with an anchoring length of only 1.5 cm, which is a typical complex neck. If conventional EVAR is performed, considering oversizing, Medtronic’s 25mm main body would be required. However, if ESAR therapy is applied, Medtronic’s 23mm main body (with 20% oversize) plus the Heli-FX™ EndoAnchor™ vascular internal anchoring system could be chosen to firmly connect the stent graft to the native aorta using anchor nails.
Maximum tumor size 75mm
Right-sided approach with localized stenosis and thrombus calcification
Surgical Plan
Surgical Procedure
Angiography before and after stent implantation:
Heli-FX Preparation:
Postoperative Review
Summary of Case Experience
Treatment of Abdominal Aortic Aneurysms with Complex Neck Anatomy, such as T-shaped necks, often involves scenarios where the proximal diameter of the stent needs to be expanded to gain additional anchoring zones in order to reduce endoleaks. However, excessive oversizing can subject the vessel wall to overly high radial pressure and poor stent apposition at the proximal end, increasing the risk of vascular injury and inducing stent-related complications, which may lead to adverse long-term outcomes. Therefore, selecting the appropriate stent diameter for T-shaped necks has always been a key focus in clinical practice.
Medtronic's Endosuture Arterial Repair (ESAR therapy) uses endovascular anchoring nails to tightly bind the stent with the blood vessel, enhancing radial fixation while improving sealing. It can effectively treat Type I endoleaks or reduce the risk of their occurrence. ESAR may provide new insights into proximal diameter selection for abdominal aortic stents in patients with complex T-shaped aneurysm necks.
In this case, the patient's abdominal aortic aneurysm neck presented a distinct T-shape, with significant angulation and only 10mm of sealing zone, representing a typical complex aneurysm neck. The surgery utilized an abdominal aortic stent one size smaller in oversizing than usual, combined with ESAR therapy, successfully sealing Type I endoleak immediately post-operation, with excellent stent fixation. The Heli-FX™ EndoAnchor™ vascular anchoring system is currently the only indicated device for Type I endoleak. Its introduction not only provides a reliable solution for stent migration and endoleaks but also offers more surgical options in clinical practice.
Heli-FX™ EndoAnchor™ Endovascular Anchoring System
Heli-FX™ EndoAnchor™ Endovascular Anchoring SystemBy mimicking surgical suturing techniques, the use of anchoring pins securely connects the stent graft to the native aorta, thereby enhancing the proximal sealing effect, effectively preventing neck dilatation, and reducing the risk of Type Ia endoleaks. Both the ANCHOR registry study and the PERU registry study have confirmed this.Heli-FX™ EndoAnchor™ Endovascular Anchoring SystemEffectiveness, safety, and significant clinical benefits.Heli-FX™ EndoAnchor™ Endovascular Anchoring SystemThe application helps to effectively isolate aneurysms, increase surgical success rates, reduce the risks of endoleaks and neck expansion, decrease the need for re-intervention, and further improve patients' quality of life.
Expert Introduction /EXPERTS
Director of the Department of General Surgery, First Affiliated Hospital of Sun Yat-sen University; Director of the Surgical Laboratory; Deputy Director of the Vascular Surgery Department; Doctor of Medicine; Chief Physician; Doctoral Supervisor; Postdoctoral Cooperation Supervisor; Postdoctoral Fellow at Stanford University School of Medicine, USA; Visiting Scholar at Leipzig Heart and Vascular Center, Germany; Outstanding Young Medical Talent of Guangdong Province.
Awarded the "First Prize of Guangdong Province Science and Technology Award" and the "First Prize of Huaxia Medical Science and Technology Award".
Deputy Director of the Vascular Surgery Branch of the Guangdong Medical Association; Chairman of the Youth Committee of the International Union of Angiology (IUA) in China; Deputy Head of the Caval and Visceral Venous Group of the Vascular Surgery Physicians Branch of the Chinese Medical Doctor Association; Deputy Director of the Vascular Surgery Branch of the China International Exchange and Promotive Association for Medical and Health Care; Deputy Director of the Vascular Surgery Physicians Branch of the Guangdong Medical Doctor Association; Deputy Director and Secretary General of the Vascular Medicine Professional Committee of the Guangdong Health Management Society; Deputy Director of the Vascular Branch of the Chinese Society of Cardiothoracic Vascular Anesthesiology; Member of the Vascular Surgery Specialty Committee of the National Cardiovascular Disease Expert Committee; Member of the Surgical Engineering and Transformation Group of the Medical Engineering Branch of the Chinese Medical Association; Executive Editorial Board Member of the Chinese Journal of Vascular Surgery (Electronic Edition); Editorial Board Member of the Chinese Journal of Experimental Surgery and the Chinese Journal of Vascular Surgery.
Ph.D. in Surgery, First Affiliated Hospital of Sun Yat-sen University; Associate Chief Physician; Master's Graduate Supervisor; Secretary of the Visceral Artery Group, Vascular Surgery Branch of the Chinese Medical Doctor Association; Member of the Vascular Surgery Branch of the Guangdong Provincial Medical Association; Member of the Vascular Surgery Branch of the Guangdong Provincial Medical Doctor Association; Standing Committee Member of the Vascular Surgery Branch of the Guangzhou Medical Doctor Association; Standing Deputy Secretary General of the Youth Committee, China Section of the International Union of Angiology; Member of the Vascular Disease Specialty Committee of the Guangdong Health Management Society; Member of the Youth Committee of the Peripheral Vascular Disease Specialty Committee of the Chinese Society of Microcirculation; Member of the Vascular Surgery Specialty Committee of the Chinese Promotion Association for Human Health Science and Technology; Review Expert for the Medical Science Edition of the Sun Yat-sen University Journal.
Skilled in the diagnosis and treatment of common diseases in vascular surgery. As the first author and corresponding author, published more than ten SCI papers; hosted one Youth Fund of the National Natural Science Foundation of China, one Doctoral Start-up Fund of the Natural Science Foundation of Guangdong Province, and participated in three projects of the National Natural Science Foundation of China.
Deputy Chief Physician of the Vascular Surgery Department at the First Affiliated Hospital of Sun Yat-sen University,Master's and Ph.D. studies were completed at the First Affiliated Hospital of Sun Yat-sen University, followed by postdoctoral research.
Long-term dedication to the diagnosis, treatment, and fundamental research of aortic and peripheral vascular diseases. Currently, has led and completed 1 postdoctoral science foundation project, with 1 ongoing youth project of the National Natural Science Foundation of China; participated in 2 general projects of the National Natural Science Foundation of China; and participated in 1 general project of the Guangdong Provincial Natural Science Foundation.
The total impact factor of previously published SCI articles reached 30.
Group Positions:Committee Member of the Peripheral Vascular Disease Branch of the Guangdong Precision Medicine Application Society;Member of the Vascular Disease Specialty Committee of the Guangdong Health Management Association.
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