Reduction of Type II Endoleaks with the Nellix EVAS System

Reduction of Type II Endoleaks
with the Nellix EVAS System Marwan Youssef
Department of Cardiothoracic and Vascular Surgery,
Medical Centre of the Johannes Gutenberg-University
Mainz, Rheinland Pfalz, Germany
Case Report Background
A 75 year-old male presented with an abdominal aortic aneurysm (AAA) having a 5.5 cm
flow lumen diameter, 23 mm non-aneurysmal neck length, 24 mm neck diameter,
12 mm left iliac diameter and 13 mm right iliac diameter. Additionally, this patient had
3 pairs of patent lumbar arteries.
75 year-old male with
5.5 cm infrarenal AAA
showing 3 pairs of
patent lumbar arteries
The Nellix EndoVascular Aneurysm Sealing (EVAS) System was implanted via transfemoral cut down and using local
anesthesia. Two 140 mm balloon expandable Nellix stents were deployed. Polymer was injected under pressure guidance
into the endobags. A total of 35 mL of polymer was injected to a target pressure of 180 mm Hg to seal the entire aneurysm.
Satisfactory sealing of the aortic aneurysm without Type II endoleak was achieved. This patient was successfully
treated using Nellix by excluding all 6 lumbar arteries and completely sealing the aneurysm. Since December 2013
to date, we have treated more than 52 patients with the Nellix EVAS device in our institution. To date, we have not
observed any endoleak especially Type II; but also no secondary interventions have been required.
Type II endoleaks are not uncommon after EVAR and the associated reintervention rate is not
insignificant. Prior to EVAS we have routinely performed preoperative embolization of the lumbar
arteries and inferior mesenteric artery as part of an EVAR procedure. Since adopting the Nellix
EVAS system, these additional interventions have no longer been required. In our experience
to date, EVAS has shown the potential to reduce endoleaks, which are the achilles heel of
endovascular repair for abdominal aortic aneurysms.
Completion angiogram
shows complete seal
of AAA sac with Nellix
device and absence
of lumbar arteries
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