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. 2019 Dec;35(4):209-216.
doi: 10.5758/vsi.2019.35.4.209. Epub 2019 Dec 31.

Initial Experience and Potential Advantages of AFX2 Bifurcated Endograft System: Comparative Case Series

Free PMC article

Initial Experience and Potential Advantages of AFX2 Bifurcated Endograft System: Comparative Case Series

EunAh Jo et al. Vasc Specialist Int. .
Free PMC article


Purpose: The AFX2 endograft is a unibody, bifurcated stent graft that can be used to lower complications in certain patients. In this study, we retrospectively reviewed consecutive cases in which the AFX2 system was used to overcome the challenges of narrow distal aorta, as well as to reduce procedure time and contrast medium dose. Furthermore, we compared the results with matched patients treated using the Endurant II endograft system.

Materials and methods: This was a retrospective observational study of nine patients with abdominal aortic aneurysm (AAA) who underwent endovascular aneurysm repair (EVAR) using the AFX2 device between June 2017 and April 2018 at Seoul National University Hospital. The patients had narrow distal aorta (n=3), reversed tapered neck (n=1), iliac artery aneurysm (n=2), chronic kidney disease patients (n=2), and impending rupture (n=1). Seven matched patients were treated using the Endurant II graft.

Results: In the AFX2 group, the mean procedure time was 87.2 minutes, mean blood loss volume was 157.7 mL, and mean volume of contrast medium used was 48.3 mL. In the Endurant II group, the mean procedure time was 140.0 minutes, mean blood loss volume was 175.0 mL, and mean volume of contrast medium used was 119.3 mL.

Conclusion: Our preliminary experiences with selected AAA patients treated using the AFX2 endovascular repair system showed good outcomes compared with similar patients treated using the Endurant II system. Therefore, the AFX2 may be a good option to perform EVAR in patients of advanced age who have chronic kidney failure or narrow distal aorta.

Keywords: AFX; Abdominal; Aortic aneurysm; Endovascular aortic aneurysm repair; Stent graft.

Conflict of interest statement

CONFLICTS OF INTEREST The authors have nothing to disclose.


Fig. 1
Fig. 1
Distal narrow aorta. Follow-up computed tomography after the AFX2 was deployed to 12 mm and 13 mm in the distal narrow aorta (A). The lumens of both limbs are patent. Both limbs are also shown well on the procedural angiography (B). EVAR, endovascular aneurysm repair.
Fig. 2
Fig. 2
Reverse tapered neck and iliac artery aneurysm. The telescope method, in which the proximal body was stacked up, was used in patient with severe angled-neck anatomy. There are no endoleaks, and the natural curve is preserved (A). The role of the AFX2 endograft in bilateral iliac aneurysm is remarkable. The proximal neck can be preserved, and a single bifurcated body is sufficient to cover the aneurysm. EVAR, endovascular aneurysm repair; CIA, common iliac aorta; IIA, internal iliac artery.
Fig. 3
Fig. 3
Reduced dose of contrast medium and impending rupture. Through the specific planning program of the AFX2 device, the size can be chosen accurately. Therefore, contrast medium to check the orifice of the renal artery can be reduced, and final angiography shows a patent renal artery (A). The reduced dose of contrast can reduce nephrotoxicity. There is no gate cannulation in the AFX2 graft, and deployment of the bifurcated body is sufficient to seal the aneurysm rupture (B). EVAR, endovascular aneurysm repair
Fig. 4
Fig. 4
Bird-beak configuration of patient treated with the AFX2 endograft.

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