Leo H van den Ham1, Andrew Holden2, Janis Savlovskis3, Andrew Witterbottom4, Kenneth Ouriel5, Michel M P J Reijnen6. 1. Department of Surgery, Department of Radiology, Rijnstate Hospital, Arnhem, The Netherlands. 2. Department of Radiology, Auckland Hospital, Auckland, New Zealand. 3. Department of Radiology, Stradins University Hospital, Riga, Latvia. 4. Department of Radiology, Addenbrooke's Hospital, Cambridge, UK. 5. Syntactx, New York, NY, USA. 6. Department of Surgery, Department of Radiology, Rijnstate Hospital, Arnhem, The Netherlands. Electronic address: mmpj.reijnen@gmail.com.
Abstract
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. Computed tomography scans were analysed by a core laboratory. A consensus meeting was organised to discuss and qualify each case for selection, technical aspects, and possible causes of the endoleak. Endoleaks were classified using a novel classification system for EVAS. RESULTS: During the study period 1851 patients were treated using EVAS at 15 centres and followed for a median of 494 ± 283 days. Among these, 58 cases (3.1%) developed a proximal endoleak (1.5% early and 1.7% late); of these, 84% of 58 patients were treated outside the original and 96% outside the current, refined, instructions for use. Low stent positioning was the most likely cause in 44.6%, a hostile anatomy in 16.1%, and a combination of both in 33.9%. Treatment, by embolisation or proximal extension, was performed in 47% of cases, with a technical success of 97%. CONCLUSION: The overall incidence of proximal endoleak after EVAS is 3.1% after a mean follow-up period of 16 months, with 1.5% occurring within 30 days. Their occurrence is related to patient selection and stent positioning. Early detection and classification is crucial to avoid the potential of sac rupture.
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. Computed tomography scans were analysed by a core laboratory. A consensus meeting was organised to discuss and qualify each case for selection, technical aspects, and possible causes of the endoleak. Endoleaks were classified using a novel classification system for EVAS. RESULTS: During the study period 1851 patients were treated using EVAS at 15 centres and followed for a median of 494 ± 283 days. Among these, 58 cases (3.1%) developed a proximal endoleak (1.5% early and 1.7% late); of these, 84% of 58 patients were treated outside the original and 96% outside the current, refined, instructions for use. Low stent positioning was the most likely cause in 44.6%, a hostile anatomy in 16.1%, and a combination of both in 33.9%. Treatment, by embolisation or proximal extension, was performed in 47% of cases, with a technical success of 97%. CONCLUSION: The overall incidence of proximal endoleak after EVAS is 3.1% after a mean follow-up period of 16 months, with 1.5% occurring within 30 days. Their occurrence is related to patient selection and stent positioning. Early detection and classification is crucial to avoid the potential of sac rupture.
Authors: Thomas F X O'Donnell; Jeffrey P Carpenter; John S Lane; Jose Trani; Sajjad Hussain; Christopher Healey; Mahmoud B Malas; Marc L Schermerhorn Journal: Ann Vasc Surg Date: 2019-10-16 Impact factor: 1.466
Authors: Aleksandra C Zoethout; Johannes T Boersen; Jan M M Heyligers; Jean-Paul P M de Vries; Clark J A M Zeebregts; Michel M P J Reijnen Journal: J Endovasc Ther Date: 2018-03-29 Impact factor: 3.487
Authors: Aleksandra C Zoethout; Arshad Sheriff; Clark J Zeebregts; Michel M P J Reijnen; Andrew Hill; Andrew Holden Journal: J Endovasc Ther Date: 2020-09-10 Impact factor: 3.487
Authors: Aleksandra C Zoethout; Iris Hochstenbach; Maarten J van der Laan; Jean-Paul P M de Vries; Michel M P J Reijnen; Clark J Zeebregts Journal: J Endovasc Ther Date: 2021-09-27 Impact factor: 3.089