Technical success and outcomes using a flexible bifurcated stent graft (Aorfix^TM) in abdominal aortic aneurysms: a systematic review

ABSTRACT

Introduction: The Aorfix aortic stent graft is a modular device with greater compliance and flexibility. This systematic review aims to assess the evidence regarding the technical success and outcomes of the Aorfix^TM stent graft.

Methods: Electronic bibliographic databases were searched. We conducted our review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards.

Results: This review of the 442 documented cases of Aorfix^TM EVAR demonstrates assisted technical success to be achieved in 97.7% of cases. The need for unplanned adjunct maneuvers was low at 9.8% and was most commonly required for resolving an intra-operative type I endoleak. The need for secondary intervention in the 1-year follow up period was even lower, at 1.3% in the same eight studies, while Malas et al reports a re-intervention rate of 7.8% at 1-year.

Conclusion: The Aorfix^TM device has been used in AAA with highly angulated proximal necks with success, with acceptable short- and midterm results. But larger multi-center comparative studies, and registry data is needed to be to compare the safety of different stent grafts and for optimal graft selection. This will increase the likely number of patients considered suitable for EVAR.

KEYWORDS:

• EVAR
• Aorfix
• vascular surgery
• endovascular aneurysm repair
• radiology

Article highlights

• A comprehensive search of several databases from each database’s inception to 17 April 2020, in humans, was conducted

• 442 documented cases of Aorfix^TM EVAR in normal and highly angulated proximal necks have demonstrated good technical success, with acceptable short- and midterm results.

• EVAR demonstrates assisted technical success to be achieved in 97.7% of cases.

• The need for unplanned adjunct maneuvers was low at 9.8% and was most commonly required for resolving an intra-operative type I endoleak.

• Six patients (1.3%) were reported to die within the peri-operative period, of which five cases were of causes not related to the aneurysm.

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.

Additional information

Funding

This paper was not funded.