ShOrt neCK AAA RAndomized Trial - ESAR and FEVAR: SOCRATES (SOCRATES)

Physician Initiated Trial Investigating ESAR (EVAR Plus Heli-FX EndoAnchors) and FEVAR for the Treatment of Aortic Aneurysms With Short Infrarenal Aortic Neck

The aim of this randomized study is to compare the safety and performance of EndoVascular Aneurysm Repair with ESAR using Endurant + Heli-FX™ EndoAnchor™ system and FEVAR using customizable grafts from Cook (Zenith Fenestrated Graft) and Terumo (Fenestrated Anaconda Graft) for the treatment of aortic aneurysms with short aortic neck (4 to 15mm).

Composite of technical success at index procedure, and freedom from type IA or type III endoleak, freedom from aneurysm related mortality (ARM), and freedom from secondary reinterventions through 12 months post index procedure.

Freedom from MAE through 30 days post index procedure. MAE defined as: All-Cause-Mortality, Bowel Ischemia, Myocardial Infraction, Procedural Blood Loss > 1000cc, Access related complications, permanent paraplegia and paraparesis at 30 days, disabling stroke, respiratory failure, or renal complications

3. Duration (minutes) of index procedure (time between initial skin access to final closure of the last artery access site)

7. Clinical success defined as technical success + freedom from intra-operative death and freedom from type IA/III endoleak in the first post-op image within 30 days.

Freedom from stent graft migration (>10mm change from 1-month follow-up imaging) at 12, 24 and 36 months follow-up

Freedom from stent graft migration (>10mm change from 1-month follow-up imaging) at 12, 24 and 36 months follow-up

Sac dynamics (>5mm change from 1-month follow-up imaging): increase, stable, decrease at 12, 24, and 36 months follow-up

Sac dynamics (>5mm change from 1-month follow-up imaging): increase, stable, decrease at 12, 24, and 36 months follow-up

reinterventions for Type IAa endoleak, migration of the proximal stent graft, and progression of disease in the infrarenal aortic neck; progression of disease is defined as enlargement of the infrarenal aortic neck compared to the first postprocedural CT scan, as measured by either diameter, surface and/or volume.

Inclusion Criteria: Subject is >18 years old Subject is scheduled for primary treatment of the abdominal aortic aneurysm with a non-aneurysmal infrarenal aortic sealing zone proximal to the aneurysm that is sufficiently healthy for a proximal neck length that is at least 4mm and not more than15 mm and has a circumferential minimum sealing zone length of 8 mm Subject is not a candidate for safe and effective standard EVAR Subject is able and willing to comply with the protocol and to adhere to the follow-up requirements. Subject has provided written informed consent Subject meets the other anatomical requirements according to the locally applicable Endurant II/IIs stent graft system, Heli-FX EndoAnchor system, Terumo Fenestrated Anaconda (available in EU only) and/or Cook Zenith Fenestrated Graft Instructions for Use Proximal neck length of the aorta within 4-15mm and a minimum circumferential sealing zone of 8mm Aortic neck diameter from 19 to 31mm Infrarenal neck angulation ≤45° Exclusion Criteria: Subject is participating in a concurrent study which may confound study results Subject has a life expectancy <2 year Subject is female of childbearing potential in whom pregnancy cannot be excluded Subject with eGFR <30 mL/min/m2 (KDOQI classification - exclude class IV and above) and or on dialysis Subject with a MI or CVA within 3 months prior to index procedure Subject with known Connective Tissue Disease Subject has a known hypersensitivity or contraindication to anticoagulants, antiplatelets, or contrast media, which is not amenable to post-treatment Subject who has undergone prior endovascular or open surgical treatment for abdominal aortic aneurysm Subject requires emergent aneurysm treatment, for example, trauma or rupture Subject has a known hypersensitivity or allergies to study device implant material Subject has an aneurysm that is: Suprarenal, pararenal, or thoracoabdominal Mycotic Inflammatory Pseudoaneurysm Subject is presenting with thrombus or calcification of the proximal aneurysm neck: circumferential >50% Pre-op stenosis of the renal arteries > 50% Subject has active infection or history of COVID-19. History of COVID-19 is defined as availability of positive COVID-19 test with sequelae or hospitalization for treatment of COVID-19.