Nineteen-year outcomes with the Anaconda stent-graft system from two tertiary centers

Abstract Objective The Anaconda stent-graft device presents peculiar and unique features in its design and deployment sequence, available on the market for many years with minor modifications among different generations. Aim of this study is to assess long-term, real life, outcomes obtained in two high-volume centers with this endograft for infrarenal aortic aneurysms treatment over a period of nineteen years. Methods All patients treated with the investigated device between 2000 and 2019, with at least one year of follow-up, were entered into a prospective database and data were retrospectively reviewed. Long-term results were assessed according to the Kaplan-Meier method. Primary outcomes were overall survival, freedom from AAA rupture, and freedom from AAA-related death. Secondary outcomes were freedom from late reintervention, freedom from late conversion to open repair, freedom from late limb occlusion, and freedom from late EVAR failure. Results A total of 260 consecutive patients were treated during the study period. Technical success was achieved in 98.5% (256/260) of the cases. Two perioperative deaths (0.8%) and four major complications (1.5%) were recorded. At a mean follow-up of 54 ± 38 months (summary follow-up index=0.86) late survival estimate was 94.8% at 1 year, 75.2% at 5 years, 50.5% at 10 years and 43.3% at 13 years with no case of late AAA rupture nor late AAA-related death. Late freedom from conversion was 99.2% at 1 year, 96.9% at 5 years, 94.0% at 10 years and 94.0% at 13 years, respectively. Freedom from late limb thrombosis was 96.8% at 1 year and 91.0% at 5, 10 and 13 years. Estimates of freedom from late reintervention was 95.6% at 1 year, 87.0% at 5 years, 77.4% at 10 years and 77.4% at 13 years. Estimates of limb thrombosis at 11 years were significantly different in patients receiving or not intraoperative iliac kissing balloon maneuver with non-compliant angioplasty catheters (98.0% vs 88.4%, p = .029). Conclusion The Anaconda stent-graft demonstrated effective and durable outcomes for AAA treatment over a nineteen-year period, with no case of late AAA rupture nor AAA related death in the studied population. Late limb occlusion was the leading cause of reintervention, however a positive prevention strategy was found in intraoperative kissing-balloon which was associated with significant reduced rate of iliac thrombosis over time.