Adjunctive distal EndoAnchor deployment to reinforce iliac seal zones in patients with high-risk anatomy: Initial experience

Although EndoAnchors are approved for proximal fixation during endovascular aortic repair (EVAR), their distal use remains investigational. This retrospective study evaluated the safety and feasibility of distal EndoAnchors in five patients with complex aortoiliac anatomy undergoing EVAR or chimney EVAR between 2020 and 2024. In addition to planned proximal fixation, anchors were deployed in the distal common iliac arteries to address complex anatomy or intraoperative type Ib endoleaks, using a specific fluoroscopic technique to protect the ureter. Distal fixation was technically successful in all cases and immediately resolved one intraoperative type Ib endoleak. No complications, such as ureteral or aortic injury, were observed, and follow-up imaging showed no evidence of type Ib endoleaks or graft migration. Preliminary results suggest distal EndoAnchor fixation may be a safe and feasible strategy for managing complex iliac sealing zones, although larger, long-term studies are needed to confirm durability.