7 research outputs found
Migration of the Nellix Endoprosthesis
Background
This study reports the incidence and sequelae of migration of the Nellix (Endologix Inc, Irvine, Calif) endoprosthesis after endovascular aneurysm sealing.
Methods
A review was performed of the follow-up imaging of all endovascular aneurysm sealing patients in a university hospital endovascular program who had a minimum follow-up of 1 year. The first postoperative and latest follow-up computed tomography scans were used to measure the distances between the proximal and distal borders of the stent grafts relative to reference vessels using a previously validated technique. Device migration was based on previously established criteria and defined as any stent graft movement of ≥4 mm related to a predefined reference vessel. Device movement in a caudal direction was given a positive value, and movement in a cranial direction was denoted by a negative value.
Results
Eighteen patients (35 stent grafts) were eligible for inclusion in this retrospective review. The mean preoperative abdominal aortic aneurysm diameter was 57 mm (standard deviation [SD], 5; range, 50-67 mm) and aortic neck length was 30 mm (SD, 16; range, 6-62 mm). Proximal migration, according to study definitions, was identified in six stent grafts (17%), all in a caudal direction. At 1 year the mean proximal migration distance was +6.6 mm (SD, 1.6; range, +4.7-+9.2 mm). Migration occurred in a single stent graft in four patients and bilaterally in one. No distal migration occurred.
Conclusions
Proximal migration of the Nellix endoprosthesis does occur and was without any sequelae in our series. Further investigations into the long-term positional stability of the Nellix device, together with a more thorough understanding of the etiology and consequences of migration, are required.
Author conflict of interest: F.T. and R.F.K. have received professional fees and educational grants from Endologix.
The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest
Endovascular aneurysm sealing (EVAS) alone or in combination with chimney grafts (chEVAS) for treating complications of previous endovascular aneurysm repair (EVAR) procedures
Objective
Late complications after previous endovascular
aneurysm repair (EVAR) procedures include type I/III
endoleaks causing aneurysm growth and rupture. We
reviewed our results from the management of such complications with endovascular aneurysm sealing (EVAS)
techniques.
Methods
Analysis of our prospectively maintained aneurysm
database was performed (December 2013–May 2017).
Primary outcomes were: (1) success of the procedure in
excluding the primary complication, (2) perioperative
mortality, (3) post-operative complications and (4)
survival.
Results
Ten consecutive patients were treated for complications
of EVAR procedures performed 2–12 years previously.
All patients underwent EVAS with/without chimney
grafts for 6 type Ia,1 type IIIb and 3 undetermined (but
presumed type IIIb) endoleaks. Overall, 19 Nellix devices
were used. The technical success with type Ia endoleaks
was 100%. All sealed using proximal extension through
chimney EVAS with 1 target vessel loss. There were no
perioperative deaths. All but 1 type Ia endoleak remained
eliminated at follow-up (range 2–29 months) as did the
proven type IIIb endoleak. Two of the 3 undetermined
endoleaks demonstrated continued sac expansion requiring
surgical exploration by laparotomy, during which type II
endoleaks were identified.
Conclusions
EVAS provides effective short-term treatment
of type Ia/IIIb endoleaks after EVAR. However, late
complications may occur due to disease progression