Aortic Aneurysm Repair Using an Endoprosthesis Designed to Eliminate Endoleaks: Three Year Follow-up

Abstract

The American Journal of Cardiology APRIL 23e26, 2013 AN aneurysm sac with a quick-setting polymer which is contained in an endobag surrounding the endoprothesis. The filled endobags obliterate the aneurysm sac while providing support and stability to the flow lumens. Methods: All patients enrolled in our center in an IRB-approved prospective clinical trial of the Nellix endograft were reviewed. Pre and post-op CT scan, procedural results, clinical outcome and follow-up CT scans at 1, 6, 12, 24 and 36 months were reviewed. Results: From 2008-2012, 24 patients, aged 69 8 years (5383yrs), with AAA diameter 5.4 0.8 cm (4.2-7.0 cm) were enrolled and treated. Aortic neck length was 25.6 16 mm (8-55mm) with neck length 60 degrees in 6 (25%) and iliac aneurysms >20mm were present in 12 (50%) cases. Complete AAA exclusion was achieved in all by filling endobags with 67 31 ml polymer (24-168 ml). Sac-filling iliac extenders were used to treat 7 common iliac (CI) aneurysms with preservation of hypogastric patency in all. Procedural success was 100%; 30 day mortality and morbidity was 0%. During a mean follow-up of 19 8 months (6-37 mo), there have been no aneurysm related deaths, no device-related adverse events and no secondary procedures. One patient died of CHF at 10 months; one patient had acute MI at 5 months and underwent PTCA. One patient had enlargement of an untreated CI aneurysm and was treated with an iliac extender at 2 years, Follow up CTs demonstrate patent endograft lumens, no device migration, no aneurysm enlargement and no new endoleaks. One patient had a transient, limited-space endoleak at 30 days which was absent at 60 days, 6, 12 and 24 months. There have been no other endoleaks. Conclusion: This novel sac-filling endoprosthesis was successful in eliminating endoleaks following endovascular aneurysm repair. Early results in treating patients with favorable as well as adverse neck and iliac anatomy is promising. This new device appears to eliminate endoleaks and reduce the need for secondary procedures. It may thus improve the long-term durability of endovascular repair. Further studies with a longer follow-up are needed.