Τhe AFX unibody bifurcated unibody aortic endograft for the treatment of abdominal aortic aneurysms: current evidence and future perspectives

ABSTRACT

Introduction: AFX is a bifurcated unibody aortic endograft for the treatment of Abdominal Aortic aneurysms. It consists of an inner metallic endoskeleton with multiple metallic struts covered by a polytetrafluoroethylene graft fabric. The endoskeleton is sutured to the outer fabric only at the proximal and distal ends. The unique design of AFX aims at fixation onto the aortic bifurcation while a proximal cuff ensures sealing at the infrarenal level.

Areas covered: Since this endograft design by Endologix has undergone significant changes over the last years, the aim of this article is to present its unique structure and deployment method and discuss the relevant clinical results as well as reported complications and associated concerns.

Expert commentary: the AFX stent-graft exhibits very satisfactory clinical mid-term results in abdominal aortic aneurysms treated within the instructions-for-use. Its ‘active-seal’ concept of infrarenal fixation stemming from the loose conjugation of the fabric material to the endoskeleton can accommodate efficiently to challenging necks with thrombus or morphological irregularities, thereby extending the anatomical sealing zone without exerting significant radial outward force. Long-term results are needed to validate the promising performance of AFX.

KEYWORDS:

• AFX
• abdominal aortic aneurysm
• Endologix
• stent-graft
• aorta
• endovascular
• unibody bifurcated endograft

Article highlights

• The “ActiveSeal” mechanism provides an extension of the AAA central sealing zone.

• Instructions for the optimal overlap between the unibody and the proximal segment have been revised to eliminate modular disconnection and endoleak type-III.

• Unique indications to use the AFX platform are saccular AAA and AAA with narrow aortic bifurcation, cases with thrombotic or irregular infrarenal neck and short length between the lowermost renal artery and the aortic bifurcation. Additionally, AFX preserves the aortic bifurcation and is ideal for patients with infrainguinal disease that would need intervention in the future.

• Recent studies confirm the technical and clinical efficacy of AFX.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.