The Safety of EVAS Surgical Conversion in a Comparative Monocentric Analysis

Marchetti, Andrea Ascoli; Oddi, Fabio Massimo; Vacca, Fabio; Orellana, Bernardo; Ippoliti, Arnaldo

doi:10.1016/j.avsg.2020.04.071

Cited by 7 publications

(4 citation statements)

References 19 publications

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“…In the present study cohort, Nellix EVAS was associated with a high incidence of explant when compared with EVAR (13% vs. <5%), but had more favourable outcome with no reported 30 day mortality. 19,20 Removal of iliac limbs was more challenging than proximal device delivery and two cases of iliac dissection were observed. Case reports describe an inflammatory reaction in the iliac arteries from the device, which predisposes to intimal damage.…”

Section: Management Of Type 1 Endoleakmentioning

confidence: 99%

Progressive Device Failure at Long Term Follow Up of the Nellix EndoVascular Aneurysm Sealing (EVAS) System

Singh

Benaragama

Pope

et al. 2021

European Journal of Vascular and Endovascular Surgery

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Section: Management Of Type 1 Endoleakmentioning

confidence: 99%

Progressive Device Failure at Long Term Follow Up of the Nellix EndoVascular Aneurysm Sealing (EVAS) System

Singh

Benaragama

Pope

et al. 2021

European Journal of Vascular and Endovascular Surgery

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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: 63%

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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“…Open conversion and device explantation is the treatment of choice for physiologically fit patients [ 4 ]. However, the mortality rate of open explantation can be significant, especially in emergency secondary ruptures [ 16 ]. Therefore, early explantation of failing devices in surgically fit patients in an elective setting is recommended by the ESVS [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Endovascular Repair of a Failed Nellix Endograft Proximal Sealing Zone Using the Altura Stent-Graft: A Case Report and Literature Review

Chatzelas,

Pitoulias,

Tsamourlidis

et al. 2023

Vasc Specialist Int

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Endovascular aortic aneurysm sealing (EVAS) with the Nellix endograft was initially considered a groundbreaking and acceptable alternative to conventional endovascular aortic aneurysm repair, with encouraging initial results. However, long-term follow-up has revealed a high incidence of endograft-related complications, such as caudal migration and type Ia endoleaks, indicating the need for reintervention. Managing failed EVAS remains challenging and is an ongoing topic of discussion, especially for high-risk patients. We describe a 70-year-old female who initially underwent EVAS with a Nellix endograft and presented after 5 years of follow-up with caudal endograft migration and a type Ia endoleak. The patient was treated with endovascular implantation of an Altura stent-graft, a relatively new low-profile device with a similar double stent configuration. Device migration and endoleaks were undetectable at 12 months of follow-up, suggesting that the Altura might offer a safe and efficient approach in cases of Nellix proximal failure.

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The Safety of EVAS Surgical Conversion in a Comparative Monocentric Analysis

Cited by 7 publications

References 19 publications

Progressive Device Failure at Long Term Follow Up of the Nellix EndoVascular Aneurysm Sealing (EVAS) System

Progressive Device Failure at Long Term Follow Up of the Nellix EndoVascular Aneurysm Sealing (EVAS) System

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

Endovascular Repair of a Failed Nellix Endograft Proximal Sealing Zone Using the Altura Stent-Graft: A Case Report and Literature Review

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