Outcome and clinical significance of delayed endoleaks after endovascular aneurysm repair

Wei, Zhou; Blay, Eddie; Varu, Vinit N.; Ali, Syed; Jin, Michelle Qiushuang; Sun, Lisa; Joh, Jin Hyun

doi:10.1016/j.jvs.2013.10.093

Cited by 73 publications

(35 citation statements)

References 16 publications

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“…Endoleak, graft migration, and aneurysm sac enlargement constitute the remaining shortcomings of endovascular aneurysm repair and underlie the observed loss of comparative clinical benefit during long-term follow-up. [3][4][5][6] The Nellix device (Endologix, Irvine, Calif) was developed with recognition that many of the complications of endovascular aortic aneurysm repair stem from inadequate isolation of the native aortic wall from pressurized blood flow. The highly differentiated Nellix platform uses polymer-filled polyurethane EndoBags surrounding balloon-expandable stents covered with expanded polytetrafluoroethylene and stabilizes the aneurysm sac by completely filling and sealing the blood flow lumen, hence the name EndoVascular Aneurysm Sealing (EVAS) system.…”

mentioning

confidence: 99%

Multicenter Nellix EndoVascular Aneurysm Sealing system experience in aneurysm sac sealing

Böckler

Holden

Thompson

et al. 2015

Journal of Vascular Surgery

122

115

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This first multicenter postmarket report of the Nellix device for infrarenal abdominal aortic aneurysm repair demonstrates satisfactory results during the initial learning phase of this new technology. The rate of aneurysm exclusion was high, and frequency of complications was low. More definitive conclusions on the value of this novel device await the results of the ongoing Nellix EVAS FORWARD Global Registry and the EVAS FORWARD investigational device exemption trial.

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mentioning

confidence: 99%

Multicenter Nellix EndoVascular Aneurysm Sealing system experience in aneurysm sac sealing

Böckler

Holden

Thompson

et al. 2015

Journal of Vascular Surgery

122

115

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“…9 Although a consensus has been reached on the management of type I and type III ELs, the management of T2EL remains a controversial subject without clear-cut guidelines, so that decision-making is totally up to the surgeon's and patient's preferences. 4 The incidence rate of T2EL was reported to be between 16% and 34%, 4,5,7,10 and T2EL vessels often stop flowing spontaneously. 4,5 However, some T2ELs might result in enlargement or rupture of aneurysms, and persistent T2ELs are associated with late adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Flow dynamics of type II endoleaks can determine sac expansion after endovascular aneurysm repair using four-dimensional flow-sensitive magnetic resonance imaging analysis

Katahashi

Sano

Takehara

et al. 2019

Journal of Vascular Surgery

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Objective: The objective of this study was to investigate the hemodynamic parameters of type II endoleaks (T2ELs) to predict sac expansion using four-dimensional flow-sensitive magnetic resonance imaging (4D-flow MRI) analysis. Methods: Patients who underwent endovascular aneurysm repair (EVAR) and were diagnosed with a T2EL were included in the study. Using 4D-flow MRI at 7 days, the peak flow velocity and amplitude of dynamics of blood flow per minute were measured in each T2EL vessel. The peak flow velocity was defined as the maximum of the absolute value of the blood flow velocity. The amplitude of dynamics of blood flow in the tributary arteries was defined as the sum of the absolute values of the inflow and outflow volume in each vessel. The amplitude of dynamics of blood flow in the tributary arteries per sac was calculated in each sac. The aneurysm sac diameter was measured by computed tomography (CT) at 1 year. The patients were divided into two groups according to the presence or absence of sac expansion. Results: Of 155 patients who underwent EVAR, both CT angiography and 4D-flow MRI were performed in 107 patients at 7 days after EVAR. Among them, 39 (36.4%) were found to have a T2EL, of whom 28 were re-evaluated with CT angiography and 4D-flow at 1 year; 7 patients had expanding sacs (expanding group), whereas 21 had nonexpanding sacs (not-expanding group). At 7 days, 28 patients had 80 T2EL vessels detected by 4D-flow MRI, of which 39 vessels (48.8%) had stopped flowing at 1 year (transient vessels); 41 vessels (51.3%) had sustained flow (persistent vessels). The persistent vessels had significantly larger peak flow velocity and amplitude of dynamics of blood flow. The comprehensive analysis of T2EL vessels per sac identified that the amplitude of dynamics of blood flow in the tributary arteries per sac was significantly higher in the expanding group than in the not-expanding group. A receiver operating characteristic curve analysis revealed that the sensitivity and specificity of sac enlargement at a cutoff value of 3750 mm 3 /min were 85.7% and 76.2%, respectively. Conclusions: The fate of aneurysm sacs with T2ELs after EVAR has remained difficult to predict. A comprehensive analysis of concurrent multiple T2EL vessels using 4D-flow MRI analysis may enable prediction of the sac expansion after EVAR.

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“…La mayor limitación de esta técnica es la necesidad de seguimiento a largo plazo mediante técnicas de imagen debido a la alta tasa de complicaciones tardías que presenta, principalmente se trata de endofugas, migraciones de prótesis, ruptura de prótesis o trombosis intraprotésica. Las endofugas son las más frecuente (17% aproximadamente) y pueden ser de 5 tipos diferentes (2,5,6,7); en nuestro caso el paciente sufrió tres tipos diferentes de éstas durante 9 años de seguimiento tras la intervención. La mayoría de estas complicaciones, sobretodo aumento del saco aneurismático por porosidad de la prótesis o migración de ésta, se han descrito con prótesis de primera generación como Excluder® de Gore o Talent® de Medtronic (en nuestro paciente se colocó esta endoprótesis), siendo menos frecuentes en las prótesis de segunda generación actuales (1).…”

Section: Sociedad Andaluza De Angiología Y Cirugía Vascularunclassified

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Outcome and clinical significance of delayed endoleaks after endovascular aneurysm repair

Cited by 73 publications

References 16 publications

Multicenter Nellix EndoVascular Aneurysm Sealing system experience in aneurysm sac sealing

Multicenter Nellix EndoVascular Aneurysm Sealing system experience in aneurysm sac sealing

Flow dynamics of type II endoleaks can determine sac expansion after endovascular aneurysm repair using four-dimensional flow-sensitive magnetic resonance imaging analysis

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