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