LATE TYPE 1A ENDOLEAK AFTER EVAS: AN UNIQUE CHALLENGE

Authors

  • Rita Augusto Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Unidade de Angiologia e Cirurgia Vascular da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
  • Ricardo Gouveia Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
  • Jacinta Campos Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Unidade de Angiologia e Cirurgia Vascular da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
  • Andreia Coelho Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Unidade de Angiologia e Cirurgia Vascular da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
  • Nuno Coelho Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Unidade de Angiologia e Cirurgia Vascular da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
  • Daniel Brandão Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Unidade de Angiologia e Cirurgia Vascular da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
  • Alexandra Canedo Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Unidade de Angiologia e Cirurgia Vascular da Faculdade de Medicina da Universidade do Porto, Porto, Portugal

DOI:

https://doi.org/10.48750/acv.305

Keywords:

Abdominal aortic aneurysm, endoleak, Onyx 34, EVAS, Nellix

Abstract

Endovascular aneurysm sealing (EVAS) using the Nellix system is an alternative method for abdominal aortic aneurysm (AAA) repair. Type 1 endoleaks are not an uncommon complication following conventional endovascular aortic aneurysm repair (EVAR), occurring in up to 10 % of cases. The incidence of these endoleaks following Nellix EVAS was determined to be up to 3,1% in short-term follow-up. Early detection and classification of this issue is crucial to avoid the potential of sac rupture, previously described. As so, we report a successful endovascular treatment of type 1a endoleak, twenty-four months after a Nellix EVAS implantation. 

An 82 year-old male underwent a Nellix endovascular repair for a 55 mm infra-renal aortic aneurysm in 2014. Final angiography showed successful aneurysm exclusion with no endoleaks. Regular follow-up using computed tomography angiography (CTA) showed a relatively satisfying good stentgraft positioning, no signs of endoleaks and shrinkage of the aneurysm sac. CTA of 2016 showed a new type 1a endoleak associated wit a significant growth of the aneurysm sac. The authors performed prompt embolization of the endoleak with 0,018” detachable coils and Onyx 34. Final angiography showed patency of the endografts with satisfactory exclusion of the endoleak. 

The incidence and significance of type 1 endoleaks following Nellix EVAS was previously studied in literature, with some cases reported and the natural history of untreated type 1 endoleak after EVAS might lead to sac rupture and death. The embolization of the endoleak with coils and Onyx appears to be a safe and effective management choice to achieve technical and clinical success in the treatment of these cases. 

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References

1. Green N, Sidloff DA, Stather PW, et al. Endoleak after endovascular aneurysm repair: 189 current status. Rev Vasc Med. 2014;2:43–7.
2. Van den Ham LH, Holden A, Savlovskis J, et al; EVAS Type IA Endoleak Study Group. Occurrence and classification of proximal type I endoleaks after endovascular aneurysm sealing using the Nellix device. Eur J Vasc Endovasc Surg. 2017;54:729–736.
3. Reijnen MM, Holden A. Status of endovascular aneurysm sealing after 5 years of commercial use. Journal of Endovascular Therapy. 2018;25(2):201–206.
4. Carpenter JP. Nellix System for endovascular aneurysm sealing: effect of IFU refinements from the EVAS FORWARD IDE. Paper presented at: The 2017 Vascular Annual Meeting of the Society for Vascular Surgery; May 31–June 3, 2017; San Diego, CA.
5. Thompson MM, Heyligers JM, Hayes PD, et al, for the EVAS FORWARD Global Registry Investigators. Endovascular aneurysm sealing: early and midterm results from the EVAS FORWARD Global Registry. J Endovasc Ther. 2016;23:685– 692.
6. Böckler D, Holden A, Thompson M, et al. Multicenter Nellix EndoVascular Aneurysm Sealing system experience in aneurysm sac sealing. J Vasc Surg. 2015;62:290–298.
7. Ameli-Renani S, Morgan RA. Secondary interventions after endovascular aneurysm sac sealing: endoleak embolization and limb-related interventions. Seminars in Vascular Surgery. 2016 Mar;29(1–2):61–7.
8. Pua U, Quek LHH, Tan GWL. Delayed Recurrence of Type 1A Endoleak with Aortic Rupture and Hemorrhage After Endovascular Aneurysm Sealing (EVAS). CardioVascular and Interventional Radiology. 2016 Jul;39(7):1061–5.
9. Ameli-Renani S, Das R, Weller A, et al. Embolisation of a proximal type I endoleak post- nellix aortic aneurysm repair complicated by reflux of onyx into the nellix endograft limb. Cardiovasc Intervent Radiol 2015;38(3):747–751.
10. Ameli-Renani S, Morgan RA. Transcatheter embolisation of proximal type I endoleaks following endovascular aneurysm sealing (EVAS) using the Nellix device: technique and out- comes. Cardiovasc Intervent Radiol. 2015;38:1137–1142.
11. Böckler D, Reijnen MM, Krievins D, et al. Use of the Nellix EVAS system to treat post-EVAR complications and to treat challenging infrarenal necks. J Cardiovasc Surg (Torino). 2014;55:601–612.
12. Reijnen MM, de Bruin JL, Mathijssen EG, et al. Global experience with the Nellix Endosystem for ruptured and symptomatic abdominal aortic aneurysms. J Endovasc Ther. 2016;23:21–28.
13. Krievins DK, Savlovskis J, Holden AH, et al. Preservation of hypogastric flow and control of iliac aneurysm size in the treatment of aortoiliac aneurysms using the Nellix EndoVascular Aneurysm Sealing endograft. J Vasc Surg. 2016;64:1262–1269.

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Published

2020-12-13

How to Cite

1.
Augusto R, Gouveia R, Campos J, Coelho A, Coelho N, Brandão D, Canedo A. LATE TYPE 1A ENDOLEAK AFTER EVAS: AN UNIQUE CHALLENGE. Angiol Cir Vasc [Internet]. 2020 Dec. 13 [cited 2024 Mar. 29];16(3):176-80. Available from: https://acvjournal.com/index.php/acv/article/view/305

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Section

Clinical Case