ChEVAS: Combining Suprarenal EVAS with Chimney Technique

Abstract

Endovascular sealing with the Nellix(®) endoprosthesis (EVAS) is a new technique to treat infrarenal abdominal aortic aneurysms. We describe the use of endovascular sealing in conjunction with chimney stents for the renal arteries (chEVAS) in two patients, one with a refractory type Ia endoleak and an expanding aneurysm, and one with a large juxtarenal aneurysm unsuitable for fenestrated endovascular repair (EVAR). Both aneurysms were successfully excluded. Our report confirms the utility of chEVAS in challenging cases, where suprarenal seal is necessary. We suggest that, due to lack of knowledge on its durability, chEVAS should only been considered when more conventional treatment modalities (open repair and fenestrated EVAR) are deemed difficult or unfeasible.

Type IIIb Endoleak and Relining

“…Nellix associated with the chimney technique has been described in juxtarenal aneurysm treatment. [18][19][20] There is thus a potential for using chimneys in relining with proximal protrusion. Indeed, there is the possibility to extend the proximal According to EUROSTAR data, 21,22 the incidence of late type III endoleak after successful EVAR is reported to be ~2% to 3%, and it has been reported with 3 commercially available endoprostheses.…”

Early Experience With Endovascular Aneurysm Sealing in Combination With Parallel Grafts for the Treatment of Complex Abdominal Aneurysms: The ASCEND Registry

“…The chEVAS technique has been described in multiple publications. [15][16][17][18][19][20] Briefly, access was gained to the renal and visceral vessels using an upper limb approach. The brachial artery was most often used for cases with a single chimney and the axillary artery (with or without a conduit) for 2 or more parallel stent-grafts.…”

Nellix Endobag rupture associated with a fatal outcome

“…The Nellix EndoVascular Aneurysm Sealing (EVAS) system (Endologix, Irvine, Calif) is a feasible option for management of type I endoleaks after endovascular aneurysm repair (EVAR). [1][2][3][4] The Nellix system involves a paired balloon-expandable endograft supported by polymer-filled endobags to achieve anatomic fixation as well as a paraprosthetic seal. In the event of an intraprocedural endobag disruption, the polyethylene glycol diacrylate polymer is reported to be unable to polymerize in the presence of blood, thereby avoiding the possibility of embolization.…”