Abstract
BackgroundEndovascular aortic sealing (EVAS) using the Nellix system was a new approach to reduce the frequency of type II endoleaks after endovascular aortic repair. We analyzed the mid-term results, specifically looking at device migration, endoleaks and subsequent necessary secondary interventions.ResultsTen patients underwent elective EVAS treatment during our study period. 7 patients were within the IFU while 3 patients had a proximal neck shorter than 10 mm. Technical success rate was 100% and there were no short-term vascular complications. One patient died from urosepsis 14 days after the procedure and was excluded from further analysis.A total of 6 out of 9 patients (67%) experienced device complications such as proximal graft kinking, limb separation or caudal migration. 5 also showed type Ia endoleak.DiscussionWhile no complication occurred short-term (up to 12 months), the Nellix system showed a high percentage of limb separation, caudal graft migration, and type Ia endoleak on mid-term follow-up, likely due to insufficient proximal anchoring of the device. Possible salvage treatments are discussed.
Highlights
Endovascular aortic sealing (EVAS) using the Nellix system was a new approach to reduce the frequency of type II endoleaks after endovascular aortic repair
We looked at the mid-term results of all patients that underwent EVAS at our center between March 2013 and July 2016
Post-procedural CT-angiographic follow-ups at 3, 6, 12, 24, and 36 months were retrospectively assessed for complications such as stent graft migration, limb separation, and endoleaks leading to subsequent secondary interventions
Summary
Endovascular aortic sealing (EVAS) using the Nellix system was a new approach to reduce the frequency of type II endoleaks after endovascular aortic repair. We analyzed the mid-term results, looking at device migration, endoleaks and subsequent necessary secondary interventions. The standard endograft concept with proximal and distal fixation and sealing is associated with a risk of endoleak occurrence, most commonly type II, a major contributor of secondary re-interventions (United Kingdom EVAR Trial investigators et al, 2010; Powel et al, 2017). The Nellix Endovascular Aneurysm Sealing System (EVAS; Endologix, Irvine, California, USA) was developed to overcome this type of adverse effect by not just sealing the device at the top and bottom, but instead filling the aneurysm sac, thereby preventing retrograde flow into the sac via lumbar or mesenteric branches. The Nellix endograft consisted of two polymer-filled polyurethane EndoBags surrounding two
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