Nellix Endovascular Aortic Sealing Endoprosthesis Late Explantation for Concomitant Type I Endoleak and Stent Frames Proximal Caudal Migration

Martinelli, Ombretta; Fresilli, Mauro; Irace, L; Gossetti, Bruno; Girolamo, Alessia Di

doi:10.1016/j.avsg.2019.03.023

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…Mortality rates for open conversions after EVAR range from 0% to 27% as described in the meta-analysis by Gambardella et al 29–32 Contrarily, reports of open aortic repair after EVAS are limited to single cases or small series, 10,16,26,33 making a direct comparison to the present study somewhat difficult. While the observed mortality rate of 23% in the present cohort had a wide confidence interval, it warrants careful analysis nonetheless.…”

Section: Discussionmentioning

confidence: 62%

“…Or rather the migration leading to loss of proximal sealing, endoleak, and subsequent aneurysm growth? 3,20,25,26 We believe that the latter is more likely the failure mechanism, as many patients (41%) presented intraoperatively with degraded polymer, making proper sac anchorage impossible. Why and how the polymer degrades was not the subject of the present study, however.…”

Section: Discussionmentioning

confidence: 97%

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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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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 97%

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

et al. 2020

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“…The chosen endoprosthesis is summarized in Table 3. The only patient submitted to EVAR with the Nellix System was excluded from this analysis because the device was not comparable to other EVARs and had known worse long-term results [7,8]. All endoprostheses, chosen according to the anatomy as underlined in Section 2, were implanted inside the IFU.…”

Section: Resultsmentioning

confidence: 99%

Clinical and Radiological Outcomes of Accessory Renal Artery Exclusion during Endovascular Repair of Abdominal Aortic Aneurysms

Girolamo,

Ascione,

Miceli

et al. 2024

Diagnostics

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Background: Accessory renal arteries (ARAs) frequently coexist with abdominal aortic aneurysms (AAA) and can influence treatment. This study aimed to retrospectively analyze the ARA’s exclusion effect on patients undergoing standard endovascular aneurysm repair for AAA. Methods: The study focused on medium- and long-term outcomes, including type II endoleak, aneurysmal sac changes, mortality, reoperation rates, renal function, and infarction post-operatively. Results: 76 patients treated with EVAR for AAA were included. One hundred and two ARAs were identified: 69 originated from the neck, 30 from the sac, and 3 from the iliac arteries. The ARA treatment was embolization in 15 patients and coverage in 72. Technical success was 100%. One-month post-operative computed tomography angiography (CTA) revealed that 76 ARAs (74.51%) were excluded. Thirty-day complications included renal deterioration in 7 patients (9.21%) and a blood pressure increase in 15 (19.73%). During follow-up, 16 patients (21.05%) died, with three aneurysm-related deaths (3.94%). ARA-related type II endoleak (T2EL) was significantly associated with the ARA’s origin in the aneurysmatic sac. Despite reinterventions were not significantly linked to any factor, post-operative renal infarction was correlated with an ARA diameter greater than 3 mm and ARA embolization. Conclusion: ARAs can influence EVAR outcomes, with anatomical and procedural factors associated with T2EL and renal infarction. Further studies are needed to optimize the management of ARAs during EVAR.

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“…Explantation of infrarenal aortic endografts has been previously described. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 To the best of our knowledge, currently, no cases have been reported on the operative technique to explant aortic endografts designed with polymer rings to facilitate a proximal seal (ALTO Abdominal Stent Graft; Endologix). Explanation, because of the polymer ring, poses unique challenges compared with other devices with suprarenal fixation.…”

mentioning

confidence: 99%

Explantation of an ALTO abdominal stent graft

Schoephoerster,

Rajaei,

Rossi

2024

Journal of Vascular Surgery Cases, Innovations and Techniques

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Nellix Endovascular Aortic Sealing Endoprosthesis Late Explantation for Concomitant Type I Endoleak and Stent Frames Proximal Caudal Migration

Cited by 6 publications

References 25 publications

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

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

Clinical and Radiological Outcomes of Accessory Renal Artery Exclusion during Endovascular Repair of Abdominal Aortic Aneurysms

Explantation of an ALTO abdominal stent graft

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