Purpose: The Nellix endovascular aneurysm sealing (EVAS) system was introduced in
2010 for infrarenal abdominal aortic aneurysm (AAA) repair. So far one
secondary type 1a endoleak resulting in rupture of the aneurysm has been
reported. Case report: We present a case of a rupture of an infrarenal
aortic aneurysm due to a secondary type 1a endoleak caused by stent migration
14 months after endovascular aneurysm sealing with a Nellix system. Conclusion: Strict adherence to anatomical requirements given by the instructions for use
during patient selection and thorough post interventional surveillance may
reduce the probability of secondary type 1a endoleaks. Furthermore, device
design changes, especially concerning the configuration of the proximal part of
the stent graft, have to be considered.
References
[1]
Bockler, D., Reijnen, M.M., Krievins, D., et al. (2014) Use of the Nellix EVAS System to Treat Post-EVAR Complications and to Treat Challenging Infrarenal Necks. The Journal of Cardiovascular Surgery, 55, 601-612.
[2]
Donayre, C.E., Zarins, C.K., Krievins, D.K., et al. (2011) Initial Clinical Experience with a Sac-Anchoring Endoprosthesis for Aortic Aneurysm Repair. Journal of Vascular Surgery, 53, 574-582. https://doi.org/10.1016/j.jvs.2010.09.009
[3]
Carpenter, J.P., Cuff, R., Buckley, C., et al. (2016) Results of the Nellix System Investigational Device Exemption Pivotal Trial for Endovascular Aneurysm Sealing. Journal of Vascular Surgery, 63, 23-31. https://doi.org/10.1016/j.jvs.2015.07.096
[4]
Cheng, L.F., Cheung, K.F., Chan, K.M., et al. (2016) Early Enlargement of Aneurysmal Sac and Separation of EndoBags of Nellix Endovascular Aneurysm Sealing System as Signs of Increased Risk of Later Aneurysm Rupture. CardioVascular and Interventional Radiology, 39, 1654-1657.
https://doi.org/10.1007/s00270-016-1416-0
[5]
Pua, U., Quek, L.H. and Tan, G.W. (2016) Delayed Recurrence of Type 1A Endoleak with Aortic Rupture and Hemorrhage after Endovascular Aneurysm Sealing (EVAS). CardioVascular and Interventional Radiology, 39, 1061-1065.
https://doi.org/10.1007/s00270-015-1291-0
[6]
Zerwes, S., Nurzai, Z., Leissner, G., et al. (2016) Early Experience with the New Endovascular Aneurysm Sealing System Nellix: First Clinical Results after 50 Implantations. Vascular, 24, 339-347. https://doi.org/10.1177/1708538115605430
[7]
Schmitz-Rixen, T., Torsello, G., Steinbauer, M., et al. (2016) The Endovascular Performance Spectrum of Vascular Surgery Departments in Germany. Gefabchirurgie, 21, 570-663. https://doi.org/10.1007/s00772-016-0157-3
[8]
Oikonomou, K., Katsargyris, A. and Verhoeven, E. (2014) Indikationen zur primaren oder sekundaren Implantation von fenestrierten Stentprothesen beim hostile AAA neck. Gefabchirurgie, 19, 220-225.
https://doi.org/10.1007/s00772-013-1276-8
[9]
Navarro, T.P., de Castro Bernardes, R., Procopio, R.J., et al. (2014) Treatment of Hostile Proximal Necks during Endovascular Aneurysm Repair. AORTA, 2, 28.
https://doi.org/10.12945/j.aorta.2014.13-030
[10]
Krievins, D.K., Holden, A., Savlovskis, J., et al. (2011) EVAR Using the Nellix Sac-Anchoring Endoprosthesis: Treatment of Favourable and Adverse Anatomy. European Journal of Vascular and Endovascular Surgery, 42, 38-46.
https://doi.org/10.1016/j.ejvs.2011.03.007
[11]
Ameli-Renani, S., Das, R., Weller, A., et al. (2015) Embolisation of a Proximal Type I Endoleak Post-Nellix Aortic Aneurysm Repair Complicated by Reflux of Onyx into the Nellixendograft Limb. CardioVascular and Interventional Radiology, 38, 747-751. https://doi.org/10.1007/s00270-014-1044-5
[12]
Holden, A., Savlovskis, J., Winterbottom, A., et al. (2016) Imaging after Nellix Endovascular Aneurysm Sealing: A Consensus Document. Journal of Endovascular Therapy, 23, 7-20. https://doi.org/10.1177/1526602815616251
[13]
Krievins, D., Savlovskis, J., Kisis, K., et al. (2013) Aortic Aneurysm Repair Using an Endoprosthesis Designed to Eliminate Endoleaks: Three Year Follow-Up. American Journal of Cardiology, 111, 7. https://doi.org/10.1016/j.amjcard.2013.01.323
