The Prophylactic and Therapeutic Use of the Heli-FX EndoAnchor System in Patients Undergoing Endovascular Aortic Aneurysm Repair—A Scoping Review

<i>Background and Objectives</i>: Proximal aortic neck-related complications severely impact the short- and long-term durability of endovascular aneurysm repair (EVAR). The Heli-FX EndoAnchor system provides proximal sealing zone reinforcement, aiming at both prevention and treatment of endograft migration and type Ia endoleak (EL Ia). The aim of this scoping review was to accumulate data on the prophylactic and therapeutic effect of EndoAnchors on patients undergoing index and revision EVAR for proximal neck complications. <i>Methods and Materials</i>: The PRISMA Extension for Scoping Reviews (PRISMA-ScR) Guidelines were followed. The literature published between 1 January 2009 and 1 September 2025 was searched by two independent reviewers. Studies reporting on morphological and clinical outcomes related to the proximal aortic neck were included. Main outcomes were Heli-FX EndoAnchor system technical success and procedural EVAR success, aortic neck dilation, endograft migration, EL Ia and proximal neck reinterventions. <i>Results</i>: Sixteen studies were included, with a total of 1164 patients. The mean follow-up ranged between 7 and 60 months. Eleven studies provided data on hostile proximal neck characteristics indicating Heli-FX EndoAnchors deployment. Technical success for prophylactic and therapeutic Heli-FX EndoAnchor application ranged between 85 and 100% as well as 86 and 100%, respectively. Procedural success for index and revision EVAR ranged between 85 and 100% as well as 45.4 and 100%, respectively. Residual EL Ia was reported in 103 patients following EndoAnchors deployment during index EVAR and revision cases. Secondary reinterventions related to the proximal sealing zone were reported in 39 patients (17 index EVAR, 19 revision). Mean aortic neck diameter increase between 2.5 and 4.6 mm was reported in four studies, while one study reported a mean >5 mm decrease. <i>Conclusions</i>: The Heli-FX EndoAnchor system was associated with high technical success, while procedural success was acceptable, amendable to neck-related characteristics, especially in revision cases for EL Ia treatment. Long-term data on morphological and clinical outcomes are warranted.