Endovascular aneurysm sealing (EVAS) alone or in combination with chimney grafts (chEVAS) for treating complications of previous endovascular aneurysm repair (EVAR) procedures

Paraskevas, KI; Karouki, M; Rehman, A; Torella, F; McWilliams, RG; England, A; Fisher, RK

Abstract

Objective
Late complications after previous endovascular
aneurysm repair (EVAR) procedures include type I/III
endoleaks causing aneurysm growth and rupture. We
reviewed our results from the management of such complications with endovascular aneurysm sealing (EVAS)
techniques.
Methods
Analysis of our prospectively maintained aneurysm
database was performed (December 2013–May 2017).
Primary outcomes were: (1) success of the procedure in
excluding the primary complication, (2) perioperative
mortality, (3) post-operative complications and (4)
survival.
Results
Ten consecutive patients were treated for complications
of EVAR procedures performed 2–12 years previously.
All patients underwent EVAS with/without chimney
grafts for 6 type Ia,1 type IIIb and 3 undetermined (but
presumed type IIIb) endoleaks. Overall, 19 Nellix devices
were used. The technical success with type Ia endoleaks
was 100%. All sealed using proximal extension through
chimney EVAS with 1 target vessel loss. There were no
perioperative deaths. All but 1 type Ia endoleak remained
eliminated at follow-up (range 2–29 months) as did the
proven type IIIb endoleak. Two of the 3 undetermined
endoleaks demonstrated continued sac expansion requiring
surgical exploration by laparotomy, during which type II
endoleaks were identified.
Conclusions
EVAS provides effective short-term treatment
of type Ia/IIIb endoleaks after EVAR. However, late
complications may occur due to disease progression.

Citation

Paraskevas, K., Karouki, M., Rehman, A., Torella, F., McWilliams, R., England, A., & Fisher, R. (2018). Endovascular aneurysm sealing (EVAS) alone or in combination with chimney grafts (chEVAS) for treating complications of previous endovascular aneurysm repair (EVAR) procedures. CardioVascular and Interventional Radiology, 41(7), 1015-1020. https://doi.org/10.1007/s00270-018-1952-x

• Journal Article Type: Article
• Acceptance Date: Mar 28, 2018
• Online Publication Date: May 3, 2018
• Publication Date: May 3, 2018
• Deposit Date: Jun 15, 2018
• Journal: CardioVascular and Interventional Radiology
• Print ISSN: 0174-1551
• Electronic ISSN: 1432-086X
• Publisher: Springer Verlag
• Volume: 41
• Issue: 7
• Pages: 1015-1020
• DOI: https://doi.org/10.1007/s00270-018-1952-x
• Publisher URL: https://doi.org/10.1007/s00270-018-1952-x
• Related Public URLs: https://link.springer.com/journal/270