European Society for Vascular Surgery (ESVS) AAA Guidelines Focused Update on patients treated with the Nellix EndoVascular Aneurysm Sealing (EVAS) system.

OBJECTIVE: To provide guidance on the surveillance and management of patients treated with Endovascular Aneurysm Seal (EVAS).

METHOD: Based on a scoping review of risk for late serious aortic-related adverse events in patients treated with EVAS for AAA, the European Society for Vascular Surgery (ESVS) AAA Clinical Practice Guidelines Writing Committee agreed on recommendations graded according to the European Society of Cardiology (ESC) grading system.

RESULTS: EVAS has a very high incidence of late endograft migration resulting in proximal type 1 endoleak with risk of rupture, requiring open conversion with device explant. The reported mortality for elective explantation varies between 0% and 14%, while acute conversion for rupture has a very dismal prognosis with 67-75% mortality.

CONCLUSION: It is recommended that all patients in whom a Nellix device has been implanted should be identified, properly informed and enrolled in enhanced surveillance. If device failure is detected, early elective device explant should be considered in surgically fit patients.