EVAR Using the Nellix Sac-anchoring Endoprosthesis: Treatment of Favourable and Adverse Anatomy

Abstract

on behalf of the PREFER study group. Eur J Vasc Endovasc Surg 2011;42:26-34. Objective: Factors influencing the choice between endovascular (endovascular aneurysm repair, EVAR) and open repair (OPEN) of abdominal aortic aneurysm (AAA) are of increasing interest. We quantified their importance among the different subjects involved in the treatment.Methods: Pre-and postoperative patients (pts), their relatives and vascular surgeons completed questionnaires evaluating six treatment characteristics: anaesthesia; recovery time to basic everyday activities; risk of re-intervention at 5 years (RR); complexity of follow-up; risk of major complications; and additional cost of intervention (AC). Through a discrete choice experiment, hypothetical scenarios of treatment were obtained and the relative importance (RI) of each characteristic was determined through a conditional logistic regression model.Results: A total of 160 pts, 102 relatives and 30 surgeons from nine centres completed the questionnaires. Major complications and re-intervention risk were the most important characteristics (RI ϭ 56.0% and 27.2%, respectively) for all the respondent categories. Pts and their relatives considered very important also a possible out-of-pocket AC. Recovery time and type of anaesthesia were among the least important characteristics, including hospital additional cost for surgeons. The different categories of respondents showed different opinions towards different treatment characteristics depending also on possible previous treatment.Conclusion: Preferences for AAA treatment characteristics differ between groups of involved subjects. Understanding individuals' preferences could help in optimising treatment benefits.

Preservation of the accessory renal arteries after endovascular repair of common iliac artery aneurysm using kissing stent grafts

“…15 Recently, a sac-anchoring endoprosthesis has been introduced, which does not require proximal and distal fixation. 16,17 Although it is not commercially available worldwide, the device might be effective in cases with an aneurysm with a short neck.…”

Transcatheter Embolisation of Proximal Type 1 Endoleaks Following Endovascular Aneurysm Sealing (EVAS) Using the Nellix Device: Technique and Outcomes

“…The incidence and significance of EL1a following Nellix EVAS is unknown with only a handful of cases reported [3][4][5]. Proximal perigraft endoleak is not uncommon following conventional EVAR occurring in up to 10 % of cases [6], and usually mandates early secondary intervention as the blood flow outside of the endograft lumen is associated with increased sac pressurisation (endotension) and a risk of rupture [7].…”

Embolisation of a Proximal Type I Endoleak Post-Nellix Aortic Aneurysm Repair Complicated by Reflux of Onyx into the Nellix Endograft Limb

“…The device is delivered via the common femoral arteries by 17 Fr (external diameter) nose delivery catheters which contain the endoframe, the surrounding endobag and ports for polymer injection, balloon inflation and angiography. The endobags mould to the The literature on the outcome of this device have been largely positive; but limited to two small series of 20 patients [1] and 34 patients [2]; the latter including 21 cases analysed in an earlier publication [3]. There are only two cases of endoleak amongst these reports.…”

“…The first was a proximal type 1 endoleak in a patient with an aortic neck angulation of more than 60°, which was transient, first found on CTA at 1-month follow-up, but absent at 2, 6 and 12 months. The other case was a distal type 1 endoleak which persisted at 12 months with no change in aneurysm sac size and successfully treated with placement of an iliac extender and coils [2].…”