Off-label use of a carotid filter to solve an unexpected complication at the active fixation of Endoanchors during EVAR

Abstract

There are few reported intraoperative complications of endoanchors during endovascular repair of aortic aneurysm (EVAR), and no cases of endoanchors fracture are described. In this case we report an unusual complication and a lucky try of bail-out. A 76 years old male affected by a 55 mm infrarenal abdominal aortic aneurysm with tortuous proximal neck of 9 mm length underwent endovascular repair with an active proximal fixation using endoanchors. One of the endoanchors fractured during its delivery and one fragment migrated proximally in the aortic lumen and stopped near the celiac trunk ostium. After several ineffective attempts of rescue using a goose-neck snaring system, it was possible to retrieve the part of the endoanchor using a carotid filter as bail out system. The procedure was finished in safety, with no complications, related and not related to surgical intervention. The rupture of an endoanchor during EVAR should be considered a possible complication, even if rare of such a procedure. It would be desiderable to promote over time the creation of dedicating bail out system in the case of structural complications of endoanchors.

Keywords

• Abdominal aneurysm
• Endoanchor
• Carotid filter
• Bail out