Preliminary outcome of Nellix-in-Nellix extensions in patients treated with failed endovascular aneurysm sealing

Zoethout, Aleksandra C.; Zerwes, Sebastian; Zeebregts, Clark J.; Heyligers, Jan M.M.; Vries, Jean Paul J.M. De; Oberhuber, Alexander; Karl, Thomas R.; Berg, P.; Stenson, Kristina; Loftus, Ian; Torella, Francesco; Szopiński, Piotr; Zimmermann, Eric; Holden, Andrew; Hyhlik‐Duerr, Alexander; Reijnen, Michel M.P.J.

doi:10.1016/j.jvs.2019.01.044

Cited by 15 publications

(9 citation statements)

References 17 publications

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“…Moreover, it was recently advised to increase the rigidity of the system in case of Nellix-in-Nellix revision for distal migration, to minimize the risk of ongoing lateral bending of the stents. 16,17 Little is known about the risk of migration after chEVAS. 4 In the present study sample, two patients required a chEVAS revision, one of whom presented with evident migration of the Nellix stents.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiography-gated computed tomography angiography analysis of cardiac pulsatility-induced motion and deformation after endovascular aneurysm sealing with chimney grafts

Koenrades

Donselaar

Erp

et al. 2020

Journal of Vascular Surgery

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Objective: To evaluate the proximal stability of the chimney endovascular aneurysm sealing configuration (chEVAS) during the cardiac cycle by investigating the cardiac pulsatility-induced movement and deformation. Methods:We retrospectively analyzed postoperative electrocardiogram-gated computed tomography angiography scans of 11 chEVAS cases (9 primary chEVAS plus 2 chEVAS-in-chEVAS). ChEVAS procedures were conducted between September 2013 and June 2016. Motion and deformation of the EVAS stents, the chimney grafts, and the stented branch vessels were evaluated during the cardiac cycle using an established combination of image registration and segmentation techniques.Results: Electrocardiogram-gated computed tomography angiography scans of 11 chEVAS configurations including 22 EVAS stents and 20 chimney grafts were analyzed. The three-dimensional displacement was at most 1.7 mm for both the EVAS stents and the chimney grafts. The maximum change in distance between components was no more than 0.4 mm and did not differ between EVAS-to-EVAS stent and EVAS stent-to-chimney stent (0.2 6 0.1 mm vs 0.2 6 0.1 mm; P ¼ .823). The mean change in chimney deflection angle was 1.2 6 0.7 ; the maximum change was greatest for the superior mesenteric artery (SMA) (2.6 ). The EVAS stent-to-chimney angles for the left renal artery, right renal artery, and SMA varied on average by 0.7 6 0.3 (range, 0.4 -1.3 ), 1.0 6 0.3 (range, 0.5 -1.7 ), and 0.8 6 0.4 (range, 0.3 -1.3 ), respectively, during the cardiac cycle. The end-stent angles for the left renal artery, right renal artery, and SMA varied on average by 1.7 6 0.9 (range, 0.5 -3.3 ), 1.9 6 0.8 (range, 0.7 -3.3 ), and 1.3 6 0.4 (range, 0.7 -1.6 ), respectively, during the cardiac cycle. Overall, the end-stent angles varied on average by 1.7 6 0.8 (range, 0.5 -3.3 ). Conclusions:The chEVAS configuration proved to be stable during the cardiac cycle, as demonstrated by minimal cyclical changes in distance between device components and angulation between the EVAS stents and the chimney grafts. The limited deflection angles of the chimney grafts decrease the risk of bending fatigue, but the more apparent change in end-stent angle distal to the chimney graft may raise concerns regarding late branch occlusion or stenosis.

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Section: Discussionmentioning

confidence: 99%

Electrocardiography-gated computed tomography angiography analysis of cardiac pulsatility-induced motion and deformation after endovascular aneurysm sealing with chimney grafts

Koenrades

Donselaar

Erp

et al. 2020

Journal of Vascular Surgery

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“…Despite CE Mark status reinstatement in June 2019 11 , availability is restricted until the next iteration of endografts. In a retrospective cohort study of 41 patients, Zoethout et al, showed 97% and 100% technical success rate in both elective and the emergency groups 12 J o u r n a l P r e -p r o o f making NINA the most acceptable method. However, there was 9% aneurysm-related death in the elective group and 44.4% in the emergency group.…”

Section: Discussionmentioning

confidence: 99%

Innovative solutions for endovascular aneurysm sealing—delayed Nellix type 1a endoleak

Ong

Tang

Wang

2021

Journal of Vascular Surgery Cases, Innovations and Techniques

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Another option is the proximal extension of the existing EVAS graft using the Nellix-in-Nellix technique. Once again, there is only preliminary experience with this procedure, 15,24 while mid- and long-term follow-ups are still missing. However, repairing an EVAS endograft that presents with a failed sealing mechanism by implanting yet another EVAS endograft that uses exactly the same sealing mechanism seems to be debatable at least.…”

Section: Discussionmentioning

confidence: 99%

“…While the device may no longer be available, dealing with EVAS complications is of major importance. Options range from endovascular approaches, such as coil embolization of endoleaks 12–14 and Nellix-in-Nellix applications, 15 to conversion to open surgery. 16 Naturally, publications on the frequency and prognostic implications of performing the aforementioned techniques are limited to small retrospective series.…”

Section: Introductionmentioning

confidence: 99%

Open Conversion After Endovascular Aneurysm Sealing: Technical Features and Clinical Outcomes in 44 Patients

et al. 2020

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Purpose To evaluate the technical features and clinical results after open conversion for complications following endovascular aneurysm sealing (EVAS). Materials and Methods From July 2013 to February 2020, 44 patients (mean age 72±8 years; 36 men) underwent an open conversion due to EVAS complications in a single center. Data were collected on patient characteristics, reasons for conversion, characteristics and duration of the procedure, condition of the polymer, blood loss, time in the intensive care unit (ICU), and intra/postoperative complications. The main outcome measure was mortality at 30 days and in follow-up. Data are presented as the median (IQR) and absolute range. Results On average, the open conversion took place 3 years after the initial EVAS implantation [median 37 months (IQR 23, 50); range 0–64]. Most patients were converted due migration (82%), aneurysm growth (77%), and/or endoleak (75%), with 21 patients (48%) having all 3 events. Less frequent diagnoses were aneurysm rupture (n=7), aortic infection (n=3), technical failure during implantation (n=2), and graft thrombosis (n=1). The majority of patients (n=26) were asymptomatic and converted electively, but 9 were operated on urgently and 9 emergently (7 late rupture and 2 due to technical failure). The median procedure duration was 178 minutes (IQR 149, 223; range 87–417), the median blood loss was 1100 mL (IQR 600, 2600; range 300–5000). Polymer degradation was mentioned in the operative reports of 18 cases (41%). Patients stayed a median of 3 days (IQR 2, 7; range 1–35) in the ICU, while the median length of stay in the hospital was 14 days (IQR 10, 20; range 0–93). The 30-day mortality was 23% (n=10). During a median follow-up of 3 months (IQR 0, 11; range 0–38), no additional deaths occurred, but 12 patients suffered from an adverse event. There were 3 cases of wound dehiscence after laparotomy, 2 cases of leg ischemia, 2 cases of renal failure, and individual cases of urinary obstruction, urinoma, paralytic ileus, gastrointestinal bleeding, and postoperative delirium. A non-elective setting was associated with a significantly increased mortality of 33% in urgent cases and 56% in emergent cases (p=0.007). Based on these results an algorithm for the management of EVAS complications was developed. Conclusion The significantly increased mortality associated with nonelective conversions highlights the need for active surveillance. The presented algorithm offers a structured tool to avoid emergency conversions.

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Preliminary outcome of Nellix-in-Nellix extensions in patients treated with failed endovascular aneurysm sealing

Cited by 15 publications

References 17 publications

Electrocardiography-gated computed tomography angiography analysis of cardiac pulsatility-induced motion and deformation after endovascular aneurysm sealing with chimney grafts

Electrocardiography-gated computed tomography angiography analysis of cardiac pulsatility-induced motion and deformation after endovascular aneurysm sealing with chimney grafts

Innovative solutions for endovascular aneurysm sealing—delayed Nellix type 1a endoleak

Open Conversion After Endovascular Aneurysm Sealing: Technical Features and Clinical Outcomes in 44 Patients

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