Incidence and Treatment of Limb Occlusion of the Anaconda Endograft After Endovascular Aneurysm Repair

Purpose: To evaluate the incidence and treatment of limb occlusions of the second- and third-generation Anaconda endografts. Methods: A single-center retrospective study was conducted involving 317 consecutive patients (mean age 76 years; 289 men) who underwent endovascular aneurysm repair for elective asymptomatic, symptomatic intact, and ruptured infrarenal abdominal aortic aneurysm with 2 versions of the Anaconda device. From September 2003 to July 2011, the second-generation device was used in 189 patients (mean age 77 years; 169 men) and from July 2011 to September 2015, the third-generation device was implanted in 128 patients (mean age 75 years; 120 men). The rates of limb occlusion were compared between groups and according to compliance with the instructions for use (IFU); predictors were sought in multivariate analysis. The results of the latter are given as the hazard ratio (HR) and 95% confidence interval (CI). Results: Kaplan-Meier freedom of occlusion estimates for second- and third-generation devices, respectively, was 96.6% and 95.0% at 1 year, 89.9% and 95.0% at 2 years, and 86.5% and 88.6% at 5 years. There was no significant difference in overall occlusion rate between the second-generation devices (p=0.332) or with regard to use within the IFU (p=0.827); however, there was a clinically relevant decrease in the occlusion rate for elective patients treated with the third-generation device (6.4% vs 13.1%, p=0.077). There was an increase in the occlusion rate when the iliac limb diameter was ≤13 mm. In multivariate analysis, the only independent predictor of limb occlusion was a small distal prosthesis diameter (HR 0.732, 95% CI 0.63 to 0.86, p<0.001). Symptomatic nonruptured and ruptured abdominal aortic aneurysm (AAA) interventions had an almost 2-fold increased risk of occlusion (HR 1.95, 95% CI 0.93 to 4.11, p=0.078), though this did not reach statistical significance. Conclusion: The Anaconda design has proven effectiveness in AAA exclusion in daily practice inside the IFU. However, efforts could be made to further reduce the limb occlusion rate.