Evolution of Computed Tomography Imaging the First Year after Endovascular Sealing of Infrarenal Aortic Aneurysms Using the Nellix Device

Ham, Leo H. van den; Mors, Thijs G. ter; Boersen, Johannes T.; Vries, J.P.P.M. de; Vriens, Patrick W.; Heyligers, Jan M.M.; Reijnen, Michel M.P.J.

doi:10.1016/j.avsg.2017.07.038

Cited by 4 publications

(2 citation statements)

References 11 publications

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“…Migration and other types of stent frame displacement have also been described by other authors, [6][7][8][17][18][19] although the definition and mea surement techniques have not been consistent in the litera ture. In contrast, van den Ham et al 20 did not observe migration in patient cohorts with high adherence to the IFU at 1 year.…”

Section: Discussionmentioning

confidence: 84%

Stent Frame Movement Following Endovascular Aneurysm Sealing in the Abdominal Aorta

Yafawi

McWilliams

Fisher³

et al. 2018

J Endovasc Ther

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Purpose. We investigated the incidence and extent of stent migration after endovascular sealing of abdominal aortic aneurysms (EVAS), its relationship with adherence to the instructions for use of the Nellix endograft and its association with aneurysm growth. Methods. In this retrospective single centre study, the clinical data and follow-up CT images of patients undergoing infra-renal EVAS with a minimum follow-up of 1 year were reviewed. The first postoperative CT scan at one month and the subsequent scans were used to measure the distances between the proximal end of the stent and reference visceral vessels using a previously validated technique. Device migration was based on the Society of Vascular Surgery definition of >10mm downward movement of either Nellix stent in the proximal landing zone; furthermore, we defined proximal displacement a downward movement of ≥4mm. Patients were categorised according to adherence to the old (2013) or new (2016) Nellix IFU. Aneurysm diameter was measured for each scan and a change of ≥5mm was deemed indicative of aneurysm growth. Results. Seventy-five patients were eligible for inclusion in our study. Over a 4-year period, migration ≥4mm occurred in 42 (56%) patients and migration of ≥10mm in 16 (21%), with similar incidence in right and left stents. Migration ≥4mm was significantly more frequent among patients whose anatomy did not conform to any IFU (p=0.025). Presence of aneurysm growth ≥5mm was observed in 14 patients (19%) and was significantly associated with proximal displacement ≥4mm (p=0.03). Conclusion. Infra-renal EVAS may be complicated by proximal displacement and migration, particularly when performed outside IFU. The definition of migration used for EVAR is inappropriate for EVAS; a new consensus on definition and measurement technique is necessary.

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Section: Discussionmentioning

confidence: 84%

Stent Frame Movement Following Endovascular Aneurysm Sealing in the Abdominal Aorta

Yafawi

McWilliams

Fisher³

et al. 2018

J Endovasc Ther

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“…However, in another recently published study on CT observations 1 year after EVAS, no migration was observed in 50 consecutive patients, of which 76% were treated inside the IFU. 15 Both patient selection and technique may have contributed to the occurrence of migration. All 3 studies, however, had a relatively short follow-up as migration usually occurs after 1 year.…”

Section: Complications and Treatmentmentioning

confidence: 99%

Status of Endovascular Aneurysm Sealing After 5 Years of Commercial Use

Reijnen

Holden

2018

J Endovasc Ther

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Endovascular aneurysm sealing (EVAS) using the Nellix Endovascular Sealing System was introduced commercially in 2013 with the aim of reducing the incidences of reintervention and late complications observed after conventional endovascular aneurysm repair (EVAR). In the 5 years since its commercial launch, the Nellix system has evolved in terms of its structure, instructions for use, and delivery technique. Complications, including migration and proximal endoleak, have been recognized and treatment strategies developed, although durability remains to be demonstrated. Prospective multicenter trials have shown a low incidence of type I endoleak and reintervention at 1-year follow-up, comparable to conventional EVAR with modern devices. Since the aneurysm sac is "actively managed" with EVAS, similar to open surgical repair, type II endoleaks are rare with the Nellix system. Unexpected benefits of active sac management with EVAS include reduced incidences of postimplantation syndrome and cardiac complications, with low all-cause mortality at 1 year. Less neck dilatation compared to EVAR has also been observed. The Nellix device and procedure continue to evolve, and further prospective studies are indicated. This article analyzes the current EVAS evidence to update our knowledge of this technique in the management of abdominal aortic aneurysm.

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Abdominal Aortic Aneurysm Volumetric Evaluation During Mid-term Follow-Up After Endovascular Sealing Using the Nellix™ Device

Batti¹,

Casciaro

Alsac

et al. 2018

Cardiovasc Eng Tech

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Evolution of Computed Tomography Imaging the First Year after Endovascular Sealing of Infrarenal Aortic Aneurysms Using the Nellix Device

Cited by 4 publications

References 11 publications

Stent Frame Movement Following Endovascular Aneurysm Sealing in the Abdominal Aorta

Stent Frame Movement Following Endovascular Aneurysm Sealing in the Abdominal Aorta

Status of Endovascular Aneurysm Sealing After 5 Years of Commercial Use

Abdominal Aortic Aneurysm Volumetric Evaluation During Mid-term Follow-Up After Endovascular Sealing Using the Nellix™ Device

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