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Ombretta Martinelli, Mauro Fresilli, Luigi Irace, Salvatore Venosi, Jihad Jabbour, Veronica Picone, Debora Maruca, Alessia Di Girolamo, Bruno Gossetti
PURPOSE: To report the use of a Nellix endovascular aneurysm sealing (EVAS) device, to successfully treat a type Ia endoleak after an endovascular aortic repair (EVAR). CASE REPORT: A 70-years old man was diagnosed with a 90-mm aortic aneurysm, suspicious for being inflammatory. It was initially treated successfully, with a Medtronic Endurant (Medtronic, Minneapolis, MN). Five years after the index endovascular repair, an asymptomatic type Ia endoleak was detected on duplex ultrasound and computed tomographic angiogram...
March 1, 2018: Annals of Vascular Surgery
J X Hing, J K Ch'ng, K H Tay, T T Chong
AIM: The Nellix was introduced to Asia in 2014. Data in Asians have been sparse. Two balloon expandable stents, each surrounded by a polymer-filled endobag are deployed in parallel to obliterate and seal the aneurysm. This paradigm shift to treating abdominal aortic aneurysms confers advantages for certain adverse aneurysm morphology that is outside the IFU for standard EVAR devices. We examine outcomes of fifteen Asian patients with concomitant infrarenal aortic and iliac artery aneurysms treated with the Nellix at our institution...
February 8, 2018: Annals of Vascular Surgery
Michel M P J Reijnen, Andrew Holden
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...
January 1, 2018: Journal of Endovascular Therapy
Anastasios Raptis, Michalis Xenos, George Kouvelos, Athanasios Giannoukas, Miltiadis Matsagkas
OBJECTIVES: The objective of this study is to analyse the flow conditions in the AFX and Nellix endografts (EGs) accounting for their postimplantation configuration in patients with an endovascular aneurysm repair-treated abdominal aortic aneurysm. METHODS: We reconstructed post-endovascular aneurysm repair computed tomography scans of patients treated with an AFX or Nellix EG creating post-implantation EG models. We examined 16 patients, 8 in each group. The blood flow properties were obtained by computational fluid dynamics simulations and were subsequently compared with physiological infrarenal blood flow properties measured in 5 healthy subjects...
January 8, 2018: Interactive Cardiovascular and Thoracic Surgery
Kosmas I Paraskevas, Francesco Torella, Charles Swaelens, Andrew England, Tze Y Chan, Usman Shaikh, Richard G McWilliams, Robert K Fisher
PURPOSE: To explore whether or not there are temporal changes in the abdominal aortic aneurysm (AAA) and intraluminal thrombus (ILT) volumes between planning and implantation of the endovascular aneurysm sealing (EVAS) device and how these changes influence lumen volume. METHODS: A retrospective review was conducted of 51 AAA patients (mean age 76±7.1 years; 36 men) in whom 2 serial preoperative computed tomography angiograms (CTAs) had been performed within 1 to 18 months before EVAS...
December 1, 2017: Journal of Endovascular Therapy
Luca Garriboli, Antonio Maria Jannello
PURPOSE: To describe the application of uncovered chimney stent grafts with the Nellix endovascular aneurysm sealing technique (ChEVAS) for juxtarenal abdominal aortic aneurysms (JAAAs). CASE REPORT: Two patients with JAAA and multiple comorbidities were considered unfit for open surgery and were selected for an endovascular approach. Fenestrated and branched endografts were too expensive, and a chimney endovascular approach was considered inappropriate for the relatively high incidence of proximal type I endoleak and graft migration...
February 2018: Vascular and Endovascular Surgery
Bruno Gossetti, Ombretta Martinelli, Michelangelo Ferri, Roberto Silingardi, Fabio Verzini
OBJECTIVE: Because of advances in technology and experience of the operator, endovascular aneurysm repair (EVAR) has supplanted open repair to treat abdominal aortic aneurysm (AAA). The low 30-day mortality and morbidity of EVAR make the endovascular approach particularly suitable for patients at high surgical risk. However, endoleak or endograft migration requiring secondary intervention or open surgical conversion is a limitation of EVAR. The Nellix system (Endologix, Inc, Irvine, Calif) has been designed to seal the entire AAA to overcome these limitations with EVAR...
December 11, 2017: Journal of Vascular Surgery
Ahmed Elbasty, Michael Crawford, Darren Morrow
Introduction: Endovascular management of aortic occlusive disease is an alternative to open surgery. This case describes the use of a Nellix graft to treat infrarenal aortic stenosis, outwith the graft indication for use. Case report: A 71 year old man with multiple comorbidities, presented with bilateral buttock claudication. A computed tomography angiogram (CTA) showed significant infrarenal aortic stenosis. Under local anaesthetic, using a percutaneous approach, Nellix grafts were inserted...
2017: EJVES Short Reports
Ruben van Veen, Kim van Noort, Richte C L Schuurmann, Jan Wille, Cornelis H Slump, Jean-Paul P M de Vries
PURPOSE: To describe and validate a new methodology for visualizing and quantifying 3-dimensional (3D) displacement of the stent frames of the Nellix endosystem after endovascular aneurysm sealing (EVAS). METHODS: The 3D positions of the stent frames were registered to 5 fixed anatomical landmarks on the post-EVAS computed tomography (CT) scans, facilitating comparison of the position and shape of the stent frames between consecutive follow-up scans. Displacement of the proximal and distal ends of the stent frames, the entire stent frame trajectories, as well as changes in distance between the stent frames were determined for 6 patients with >5-mm displacement and 6 patients with <5-mm displacement at 1-year follow-up...
February 2018: Journal of Endovascular Therapy
Leo H van den Ham, Andrew Holden, Janis Savlovskis, Andrew Witterbottom, Kenneth Ouriel, Michel M P J Reijnen
OBJECTIVE/BACKGROUND: Proximal type I endoleaks are associated with abdominal aortic aneurysm (AAA) growth and rupture and necessitate repair. The Nellix™ EndoVascular Aneurysm Sealing (EVAS) system is a unique approach to AAA repair, where the appearance and treatment of endoleaks is also different. This study aimed to analyse and categorise proximal endoleaks in an EVAS treated cohort. METHODS: All patients, treated from February 2013 to December 2015, in 15 experienced EVAS centres, presenting with proximal endoleak were included...
December 2017: European Journal of Vascular and Endovascular Surgery
Stefan Ockert, Mirjam Heinrich, Thomas Kaufmann, Thomas Syburra, Ruben Lopez, Robert Seelos
OBJECTIVE: To analyze radiation exposure during endovascular aortic sealing (EVAS) in comparison with standard endovascular aortic repair (EVAR) in clinical practice. METHODS: From December 2013 to October 2016 (35 months), 60 patients were analyzed for intraoperative radiation exposure during EVAR: 30 consecutive patients (mean age, 73.10 years; 28 male) received EVAS (Nellix Endologix); within the same time frame, 30 patients were treated with standard EVAR (mean age, 71...
October 9, 2017: Journal of Vascular Surgery
Leo H van den Ham, Thijs G Ter Mors, Johannes T Boersen, Jean Paul P M de Vries, Patrick W Vriens, Jan M Heyligers, Michel M P J Reijnen
BACKGROUND: The Nellix endovascular aneurysm sealing (EVAS) system is an alternative endovascular treatment option for infrarenal aortic aneurysms (AAAs), with a unique appearance on computed tomography angiography (CTA). Normal evolution of post-EVAS CTA appearance follow-up is still largely unknown and important to timely detect eventual complications. The objective is to assess the normal appearance of CTA images 30 days and 1 year after EVAS in 50 consecutive patients. METHODS: Fifty patients treated with Nellix EVAS for an infrarenal AAA were included from 3 hospitals...
September 12, 2017: Annals of Vascular Surgery
Brandon W Propper, Shaun Gifford, Sean Hislop, Michael Clemens, Zachary M Arthurs
BACKGROUND: Endovascular Aortic Sealing (EVAS) represents a recent transformation in approach for treatment of aortic aneurysms. Initial reporting has shown that EVAS using the Nellix device is safe with similar complication rates to standard endovascular aortic repair (EVAR). What remains unknown is how EVAS technology will behave in the ruptured setting. The purpose of this report is to discuss how EVAS system and endobag technology behave when deployed in a porcine model of aortic rupture...
September 5, 2017: Annals of Vascular Surgery
Chris Klonaris, Athanasios Katsargyris, Dimitris Athanasiadis, Theodor Liakakos
PURPOSE: To report endovascular treatment of a symptomatic type V thoracoabdominal aortic aneurysm (TAAA) using the combined techniques of endovascular aneurysm sealing and parallel stent-grafts. CASE REPORT: A 70-year-old man was referred with a symptomatic type V TAAA. The Nellix EndoVascular Aneurysm Sealing (EVAS) System was used in combination with 2 chimney grafts for the celiac artery (CA) and the superior mesenteric artery (SMA); one periscope graft perfused the right renal artery...
September 1, 2017: Journal of Endovascular Therapy
Johannes T Boersen, Erik Groot Jebbink, Lennart Van de Velde, Michel Versluis, Guillaume Lajoinie, Cornelius H Slump, Jean-Paul P M de Vries, Michel M P J Reijnen
PURPOSE: To examine the influence of device positioning and infrarenal neck diameter on flow patterns in the Nellix endovascular aneurysm sealing (EVAS) system. METHODS: The transition of the aortic flow lumen into two 10-mm-diameter stents after EVAS creates a mismatched area. Flow recirculation may affect local wall shear stress (WSS) profiles and residence time associated with atherosclerosis and thrombosis. To examine these issues, 7 abdominal aortic aneurysm flow phantoms were created, including 3 unstented controls and 3 stented models with infrarenal neck diameters of 24, 28, and 32 mm...
July 1, 2017: Journal of Endovascular Therapy
Ç Ünlü, R C L Schuurmann, J P P M de Vries
Despite improvements in endograft design, operator skills, and patient selection, late endovascular abdominal aortic aneurysm repair (EVAR) associated complications and need for reinterventions remains the Achilles heel. These complications erode the early benefit over open aneurysm repair during long-term follow-up. The recently introduced endovascular aneurysm sealing (EVAS) is an innovative technology with the intention to lower these EVAR related complications. Areas covered: In this review the EVAS technique, indications, and possible applications, will be discussed, as well as a critical appraisal of clinical outcomes...
July 11, 2017: Expert Review of Medical Devices
Daniele Psacharopulo, Michelangelo Ferri, Emanuele Ferrero, Sandeep S Bahia, Andrea Viazzo, Alberto Pecchio, Fulvio Ricceri, Franco Nessi
OBJECTIVE: The objective of this study was to evaluate the results of the off-label use of the Nellix endograft (Endologix, Irvine, Calif) for the treatment of short-neck aneurysms and juxtarenal aortic aneurysms (JAAs) compared with the outcomes of patients with infrarenal abdominal aortic aneurysms treated in accordance with the manufacturer's instructions for use. METHODS: Data available from patients treated with the Nellix endograft from September 2013 to January 2016 were reviewed to create a case-control analysis (1:2)...
November 2017: Journal of Vascular Surgery
Ombretta Martinelli, Luigi Irace, Roberto Gattuso, Cristina Belli, Mauro Fresilli, Bruno Gossetti
We report a case of type 1 endoleak with an outflow via a lumbar artery (LA) following Nellix endovascular aneurysm sealing (EVAS) to discuss the specific peculiarities and management of this complication. A 64-year-old man (acetylsalicylic acid 3) underwent Nellix EVAS for an asymptomatic infrarenal aortic aneurysm. The 6-month duplex scanning ultrasound and magnetic resonance imaging showed a type IA endoleak with an outflow via an LA combined with a stable aneurysmal sac size. The subsequent 9-month imaging controls showed no changes of the endoleak cavity, but there was a slight enlargement in proximal neck size associated with the distal migration of both Nellix grafts...
May 24, 2017: Annals of Vascular Surgery
Jan P Frese, Ioannis T Passaloglou, Anita Micheel, Alexandra Gratl, Erik L Franzen, Safwan Omran, Andreas Greiner
The Nellix aneurysm sealing system aims at sealing the cavity of the sac of the aneurysm, to reduce typical complications such as migration or endoleak. We report on a case of a unique device-associated complication: rupture and displacement of the filling material into the aortic lumen, causing peripheral ischemia and imminent renal and visceral occlusion, in a patient with anastomotic ulcer after an open aortobiiliac bypass and calcified and tortuous iliac arteries. The material was removed by open surgery...
August 2017: Annals of Vascular Surgery
I Ben Abdallah, S El Batti, M Abou-Rjeili, J-N Fabiani, P Julia, J-M Alsac
OBJECTIVE: To report experience with open conversion (OC) after previous failed EVAR and to compare outcomes of patients undergoing elective OC with those operated on in an urgent setting. METHODS: Patients undergoing OC after EVAR between August 2008 and September 2016 were included in this retrospective and observational single institution study. Indications, demographic, anatomical, intra-operative and post-operative data were collected prospectively. Primary endpoints were 30 day and in hospital mortality...
April 5, 2017: European Journal of Vascular and Endovascular Surgery
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