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A novel method of endovascular aneurysm sealing (EVAS) in patients with abdominal aortic aneurysm


Authors: P. Šedivý 1;  H. Přindišová 2;  K. El Samman 1
Authors‘ workplace: Oddělení cévní chirurgie, Nemocnice Na Homolce, Praha, primář: prof. MUDr. P. Štádler, Ph. D. 1;  Oddělení radiodiagnostiky, Nemocnice Na Homolce, Praha, primář: prof. MUDr. J. Vymazal, DrSc. 2
Published in: Rozhl. Chir., 2015, roč. 94, č. 6, s. 238-241.
Category: Original articles

Overview

Introduction:
Endovascular stent graft therapy of abdominal aortic aneurysms is sometimes complicated due to unusual anatomy of the aorta and adjacent arterial regions, an irregular or short proximal neck, numerous patent branches originating from the aneurysm, or tortuous iliac arteries. Endovascular aneurysm sealing is a new method designed to overcome certain limitations of current stent grafts.

Method:
At the Department of Vascular Surgery of Na Homolce Hospital, we implanted 51 stent grafts in the subrenal aorta and iliac arteries. Most of them were regular bifurcated stent grafts. Two patients were treated with the new Nellix stent graft, in one case due to a short subrenal neck of only 13 mm, and due to a considerably conical neck in the second case.

Results:
The post-operative course was uneventful in both patients and they were discharged on the 5th postoperative day. CT angiography after six weeks proved that the stent graft had sealed well. The polymer filled the aortic lumen completely.

Conclusion:
This new method of endovascular aneurysm sealing (EVAS) of abdominal aortic aneurysm makes it possible to treat patients whose anatomy would normally require technically complex and more expensive endovascular methods. We aim to follow long-term results of the method in larger patient cohorts.

Key words:
abdominal aortic aneurysmstent grafts − endoleak


Sources

1. Becquemin J, Pillet J, Lescallie F, et al. ACE trialists. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate- risk patients. J Vasc Surg 2011;53:1167−73.

2. Blair R, Collins A, Harkin D. Complex EVAR for abdominal aorto-iliac aneurysms (AAIA) is associated with high rate of endoleak and less aortic sac shrinkage compared to conventional EVAR for AAA. Ir J Med Sci 2014; ahead of print.

3. Wain R, Marin M, Ohki T, et al. Endoleaks after endovascular graft treatment of aortic aneurysms: classification, risk factors and outcome. J Vasc Surg 1998;27:69−78.

4. Cieri E, De Rango P, Isernia G, et al. Type II endoleak is an enigmatic and unpredictable marker of worse outcome after endovascular aneurysm repair. J Vasc Surg 2014;59:930−7.

5. Ward T, Cohen S, Patel R, et al. Anatomic risk factors for type-2 endoleak following EVAR: a retrospective review of preoperative CT angiography in 326 patients. Cardiovasc Intervent Radiol 2014;37:324−8.

6. Al-Jubbouri M, Comerota A, Thakur S, et al. Reintervention after EVAR and open surgical repair of AAA: a 15-year experience. Ann Surg 2013;258:652−8.

7. Verzini F, Isernia G, De Rango P, et al. Abdominal aortic endografting beyond the trials: a 15-year single-center experience comparing newer to older generation stent-grafts. J Endovasc Ther 2014;21:439−47.

8. Karthikesalingam A, Cobb R, Khoury A, et al. The morphological applicability of a novel endovacular sealing (EVAS) system (Nellix) in a patient with abdominal aortic aneurysms. Eur J Vas Endovasc Surg 2013;46:440−5.

9. Löwenthal D, Herzog L, Rogits B, et al. Identification of predictive CT angiographic factors in the development of high-risk type 2 endoleaks after endovascular aneurysm repair in patients with infrarenal aortic aneurysms. Rofo 2015;187:49−55.

10. Boeckler D, Reijnen M, Krievins D, et al. Nellix for post-EVAR complications and to treat challenging infrarenal necks. J Cardiovasc Surg 2014;55:601−12.

11. Dijkstra M, Lardenoye J, van Oostayen J, et al. Endovascular aneurysm sealing for juxtarenal aneurysm using the Nellix device and chimney covered stents. J Endovasc Ther 2014; 21:541−7.

12. Malkawi A, de Bruin J, Loftus I, et al. Treatment of a juxtarenal aneurysm with the Nellix Endovascular aneurysm sealing system and chimney stent. J Endovasc Ther 2014;21:538−40.

Labels
Surgery Orthopaedics Trauma surgery
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