The number and complexity of aortic aneurysms treated by fenestrated endovascular stent-grafts have increased dramatically over the last 10 years. An example of these stent grafts is the Terumo Aortic Anaconda Endovascular Aortic Stent Graft System which has been used since 2010 and is one of two widely used platforms. This study reports a multi-centre case series of Anaconda Stent Graft with proximal ring fractures.

This is a multi-centre retrospective case series of prospectively collected data of proximal ring fractures in patients who underwent fenestrated endovascular aortic aneurysm repair (FEVAR) with the Anaconda Stent Graft between 2010 and 2021 in two United Kingdom tertiary vascular centres (the Freeman Hospital, Newcastle and the Royal Derby Hospital, Derby).

15 patients (median age 68 years [64-88]) out of 253 patients who underwent FEVAR with the Anaconda Stent Graft System, were found to have incidental fractures of the proximal sealing ring on routine stent graft surveillance between 23/03/2013 and 12/11/2021. Fractures were detected by Computed Tomography angiograms and plain X-ray radiographs. Four cases showed wire fracture from the proximal sealing ring and migration to the surrounding tissue/organs. One patient developed aneurysm sac expansion with type IA due to stent migration and subsequently developed one fenestration occlusion requiring secondary intervention. Other patients (14 out of 15) did not show stent migration or loss of the proximal sealing zone and are currently managed conservatively with no clinical harm identified to date.

This case series reports proximal ring stent fracture in Fenestrated Anaconda Stent Graft in 15 patients in two UK tertiary vascular centres. Early and pre-liminary data in this case series highlight the importance of surveillance following aortic endograft placement. However, a wider review across additional centres is required to understand the clinical consequences of stent ring fracture as well as any adverse anatomical prognostic features.