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Robert M Van Haren, Lee J Goldstein, Omaida C Velazquez, Jagajan Karmacharya, Arash Bornak
OBJECTIVE: Aortobifemoral bypass has been the gold standard treatment for extensive aortoiliac occlusive disease. Endovascular therapy and stenting of aortic and iliac occlusive lesions has proven to be efficacious, especially when dealing with short segment lesions. Endovascular treatment of TransAtlantic Inter-Society Consensus II (TASC) D aortoiliac occlusive lesions remains a challenge, but a valuable treatment option in poor surgical candidates. We present our operative technique and midterm results in treating TASC D aortoiliac occlusive disease using unibody bifurcated endografts...
October 17, 2016: Journal of Vascular Surgery
Arne de Niet, Michel Mpj Reijnen, Ignace Fj Tielliu, Jan Willem Hp Lardenoije, Clark J Zeebregts
Since the introduction of fenestrated endovascular aneurysm repair (FEVAR) in 1996, great advances have been made in endograft development. Custom-made and off-the-shelf fenestrated and branched endografts have been used to treat patients with complex abdominal aortic and thoraco-abdominal aneurysms. Most experience has been gained with the Cook Zenith® fenestrated endograft (Cook Medical Inc., Limerick, Ireland). The Cook Zenith® endograft is customized with fenestrations, (fixed) inner or outer branches, or a combination of them, to cover a wide range of complex aneurysms...
October 6, 2016: Surgical Technology International
Ombretta Martinelli, Alban Malaj, Roberto Gattuso, Luigi Irace, Bruno Gossetti
The aim of this study is to present the treatment of a juxtarenal inflammatory aneurysm using a Nellix device (Endologix, Inc., Irvine, CA) to seal the entire aneurysmatic aorta combined with bilateral iliac-renal bypass using the Gore hybrid vascular graft (W. L. Gore & Associates, Inc., Flagstaff, AZ). A 63-year-old man was diagnosed with a 6-cm juxtarenal inflammatory aneurysm. It was initially decided to treat him with an aorto-aortic bypass and to revascularize the 2 renal arteries with "graft to renal artery bypass" using Gore hybrid vascular grafts...
September 22, 2016: Annals of Vascular Surgery
Naseem Helo, Arthur C Chang, Christine Hyun, Kenneth S Chon, Alex C Yi
Endoleaks remain a main concern in endovascular aneurysm repair. A potential false positive in the diagnosis of endoleak surveillance includes "billowing," a phenomenon of the polytetrafluoroethylene plastic outer fabric of the stent graft is seen separated from the struts of the metallic endoskeleton. Contrast presents beyond the endoskeleton but is still contained within the graft. This is secondary to intermittent attachment of the graft to the endoskeleton, and is only found in the Endologix Powerlink. The finding of billowing has been previously reported and is a common knowledge by those who deploy the stent graft...
August 2016: Annals of Vascular Surgery
Gary W Lemmon, Rahgu L Motaganahalli, Tiffany Chang, James Slaven, Ben Aumiller, Bradford J Kim, Michael C Dalsing
OBJECTIVE: Type III (T-III) endoleaks following endovascular aneurysm repair (EVAR) remain a major concern. Our center experienced a recent concentration of T-III endoleaks requiring elective and emergency treatment and prompted our review of all EVAR implants over a 40-month period from April 2011 until August 2014. This report represents a single center experience with T-III endoleak management with analysis of factors leading to the T-III-related failure of EVAR. METHODS: A retrospective review of all the operative reports, medical records, and computed tomography scans were reviewed from practice surveillance...
September 2016: Journal of Vascular Surgery
T S Maldonado, G G Westin, O Jazaeri, M Mewissen, M M P J Reijnen, A J Dwivedi, H E Garrett, A Dias Perera, T Shimshak, V Mantese, C J Smolock, Z M Arthurs
OBJECTIVE/BACKGROUND: Aorto-bifemoral bypass remains the gold standard for treatment of aortoiliac occlusive disease (AIOD) in patients with advanced (TASC D) lesions, but has significant associated morbidity and mortality. Treatment with a unibody stent-graft positioned at the aortic bifurcation is a potential endovascular option for the treatment of AIOD. The current study examines the safety, efficacy, and early patency rates of the Endologix AFX unibody stent-graft for treatment of AIOD...
July 2016: European Journal of Vascular and Endovascular Surgery
Andrew England, Francesco Torella, Robert K Fisher, Richard G McWilliams
BACKGROUND: This study reports the incidence and sequelae of migration of the Nellix (Endologix Inc, Irvine, Calif) endoprosthesis after endovascular aneurysm sealing. METHODS: A review was performed of the follow-up imaging of all endovascular aneurysm sealing patients in a university hospital endovascular program who had a minimum follow-up of 1 year. The first postoperative and latest follow-up computed tomography scans were used to measure the distances between the proximal and distal borders of the stent grafts relative to reference vessels using a previously validated technique...
April 9, 2016: Journal of Vascular Surgery
Alex Wu, Karunakaravel Karuppasamy, Weiping Wang
INTRODUCTION: Endoleaks remains one of the primary concerns of endovascular aortic aneurysm repair (EVAR) and is routinely followed with CT angiography (CTA). However, certain imaging findings can mimic endoleaks. CASE PRESENTATION: A 65-year-old woman who had endovascular aortic repair (EVAR) of an abdominal aortic aneurysm with Endologix Powerlink system developed marked new circumferential cauliflower-like bulging of contrast-filled sacs at mid-stent-graft with enlargement of the excluded aneurysm at 3-year follow-up...
May 2016: Research in Cardiovascular Medicine
Marwan Youssef, Friedrich Dünschede, Hazem El Beyrouti, Ora Salem, Christian-Friedrich Vahl, Bernhard Dorweiler
Background We demonstrate our initial experience and first results of the endovascular aneurysm sealing (EVAS) technology with chimney grafts for the treatment of paravisceral aneurysms. Methods We present a consecutive series of seven patients with a mean age of 75 years who had been treated by four-vessel-chimney EVAS (ChEVAS) between May 2014 and May 2015. All patients were ASA grade ≥ III and were not eligible for fenestrated/branched endovascular aortic repair (fEVAR/brEVAR) due to urgency (n = 5) or anatomical constraints (n = 2)...
February 18, 2016: Thoracic and Cardiovascular Surgeon
John Julian Harvey, Brew Stefan, Andrew Hill, Andrew H Holden
The successful transcatheter treatment of a type IA endoleak after endovascular aortic aneurysm sealing with the Nellix EndoVascular Aneurysm Sealing system (Endologix Inc, Irvine, California) using proximal covered stent extension and transarterial N-butyl cyanoacrylate sac embolization is described. Three patients were treated using the same technique with a mean interval between the index procedure and reintervention of 9.3 months (range, 3-15 mo). No complications or endoleaks were seen on follow-up imaging...
February 2016: Journal of Vascular and Interventional Radiology: JVIR
J T Boersen, R C L Schuurmann, C H Slump, D A F van den Heuvel, M M P J Reijnen, T G ter Mors, A C Vahl, J P P M de Vries
OBJECTIVE: Endovascular aortic sealing (EVAS) with the Nellix endosystem (Endologix, Irvine, CA, USA) is a new concept to treat infrarenal abdominal aortic aneurysms (AAAs). By sealing the aneurysm, potential endoleaks may be avoided. Early results of EVAS are good, but no data have been published regarding peri-procedural changes in aortoiliac anatomy. In this study, 27 consecutive patients who underwent elective EVAS repair of an AAA were reviewed. METHOD: Specific AAA (diameter, length from renal arteries to aortic bifurcation, supra- and infrarenal neck angulation, AAA volume, thrombus volume, and flow lumen volume), and iliac artery characteristics (length, angulation, location of most severe angulation with reference to the origin of the common iliac artery) were determined from pre- and post-procedural reconstructed computed tomography angiograms...
January 2016: European Journal of Vascular and Endovascular Surgery
Janis Savlovskis, Dainis Krievins, Jean-Paul P M de Vries, Andrew Holden, Kaspars Kisis, Marcis Gedins, Natalija Ezite, Christopher K Zarins
OBJECTIVE: This study evaluated changes in aortic neck diameter after endovascular aneurysm repair (EVAR) using a balloon-expandable stent (BES) endograft compared with a commercially available self-expanding stent (SES) endograft. We hypothesized that forces applied to the aortic neck by SES endografts may induce aortic neck enlargement over time and that such enlargement may not occur in aneurysm patients treated with a device that does not use a proximal SES. METHODS: This was a retrospective quantitative computed tomography (CT) image analysis of patients treated with the Nellix (Endologix, Irvine, Calif) BES (n = 49) or the Endurant II (Medtronic, Minneapolis, Minn) SES (n = 56) endograft from 2008 to 2010...
September 2015: Journal of Vascular Surgery
Afshin A Skibba, James R Evans, David Tyler Greenfield, Heesuk Richard Yoon, Tony Katras, Kenneth Ouriel, Daniel S Rush
OBJECTIVE: Junctional component separation producing type IIIa endoleak after endovascular abdominal aortic aneurysm repair (EVAR) is an uncommon but serious complication requiring unanticipated reinterventions. This retrospective study analyzed main-body EVAR component uncoupling and type IIIa endoleaks encountered with Powerlink and AFX (Endologix Inc, Irvine, Calif) endografts during an 8-year period. METHODS: Type IIIa endoleaks were identified from a database of secondary interventions and clinical surveillance...
October 2015: Journal of Vascular Surgery
Emanuele Ferrero, Daniele Psacharopulo, Michelangelo Ferri, Giuseppe Berardi, Andrea Viazzo, Alberto Pecchio, Franco Nessi
The Nellix device (Endologix, Irvine, CA), has been designed with a brand new concept to seal the abdominal aortic aneurysms, minimizing endoleaks and reducing reinterventions. We present the first open conversion of a Nellix endograft due to aortoduodenal fistula of a 74-year-old male patient treated for an abdominal aortic aneurysms of 62-mm diameter.
October 2015: Annals of Vascular Surgery
Leo H van den Ham, Clark J Zeebregts, Jean-Paul P M de Vries, Michel M P J Reijnen
Since the dawn of endovascular aortic aneurysm repair (EVAR), starting from its initial report in 1991, there has been a significant evolution in stent graft design and delivery systems. Complications, mostly endoleaks, and re-intervention rates after EVAR remain amongst the most challenging aspects in comparison with traditional open repair. The use of a sac-anchoring endograft changes the approach of aneurysm exclusion. The Nellix™ EndoVascular Aneurysm Sealing system (Endologix Inc., Irvine, CA) consists of balloon expandable stents surrounded by endobags that are filled with a polymer thereby sealing the aneurysm...
May 2015: Surgical Technology International
Dittmar Böckler, Andrew Holden, Matt Thompson, Paul Hayes, Dainis Krievins, Jean-Paul P M de Vries, Michel M P J Reijnen
OBJECTIVE: Despite improvements in endograft devices, operator technique, and patient selection, endovascular repair has not achieved the long-term durability of open surgical aneurysm repair. Persistent or recurrent aneurysm sac flow from failed proximal sealing, component failure, or branch vessel flow underpins a significant rate of reintervention after endovascular repair. The Nellix device (Endologix, Irvine, Calif) employs a unique design with deployment of polymer-filled EndoBags surrounding the endograft flow lumens, sealing the aneurysm sac space and potentially reducing complications from persistent sac flow...
August 2015: Journal of Vascular Surgery
A Holden
The deficiencies in current endovascular aneurysm repair include limited applicability to treat aneurysm anatomies, a significant reintervention rate to manage postprocedural complications and a requirement for postprocedural surveillance. Endovascular aneurysm sealing with the Nellix™ device offers the potential to address these issues by directly treating the aneurysm sac and minimizing the risk of endoleak of any type as well as device migration. The unique sealing technology of polymer filled endobags also provides an opportunity to treat aneurysm anatomies that could not be effectively treated with conventional endografts...
June 2015: Journal of Cardiovascular Surgery
Bernardo C Mendes, Gustavo S Oderich, Thanila A Macedo, Alexandre A Pereira, Stephen Cha, Audra A Duncan, Peter Gloviczki, Thomas C Bower
OBJECTIVE: The objective of this study was to evaluate the anatomic feasibility of two off-the-shelf fenestrated stent graft designs to treat juxtarenal and pararenal abdominal aortic aneurysms (AAAs). METHODS: Digital computed tomography angiograms were analyzed in 520 consecutive patients treated by open or fenestrated endovascular repair for complex AAAs (2000-2012). The anatomic feasibility of two off-the-shelf fenestrated designs, Endologix Ventana (Endologix Inc, Irvine, Calif) and Cook p-Branch (Cook Medical, Brisbane, Australia), was analyzed with the instructions for use (IFU) proposed by investigational protocols...
October 2014: Journal of Vascular Surgery
M Burress Welborn, Huey B McDaniel, Ronny C Johnson, Ronald E Kennedy, Andrew Knott, Gerhard H Mundinger, Fred S Stucky, Kenneth Ouriel
OBJECTIVE: Despite improvements in endograft technology, operator skill, and patient selection, endovascular aneurysm repair continues to be associated with device-related complications. A retrospective, observational study was undertaken to evaluate the clinical outcome and imaging findings of a unique device having externally-mounted, conformable graft material. METHODS: Infrarenal abdominal aortic aneurysms were treated with the Endologix, Inc AFX endovascular aortic aneurysm system (Irvine, Calif) endograft in 108 consecutive patients over a 25-month period at two U...
October 2014: Journal of Vascular Surgery
Mark A Farber, Raghuveer Vallabhaneni, William A Marston
BACKGROUND: Fenestrated devices currently require a 3- to 4-week manufacturing period before implantation; as such, there have been efforts to develop "off-the-shelf" (OTS) devices to reduce the time before definitive treatment can be accomplished. We examined all patients treated for complex aortic problems at our institution during the past 12 months to evaluate the suitability and early outcomes of the OTS devices vs commercially available endovascular options. METHODS: Between July 2012 and September 2013, patients undergoing aortic aneurysm repair were extracted from a prospectively managed aortic database...
September 2014: Journal of Vascular Surgery
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