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Editor's Choice – Occurrence and Classification of Proximal Type I Endoleaks After EndoVascular Aneurysm Sealing Using the Nellix™ Device
- Source :
- European Journal of Vascular and Endovascular Surgery. 54:729-736
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
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.
- Subjects :
- Male
medicine.medical_specialty
Endoleak
medicine.medical_treatment
Technical success
Early detection
Computed tomography
030204 cardiovascular system & hematology
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Aneurysm
Risk Factors
Humans
Medicine
Aged
Retrospective Studies
Aged, 80 and over
medicine.diagnostic_test
business.industry
Incidence
Incidence (epidemiology)
Endovascular Procedures
Stent
Middle Aged
medicine.disease
Abdominal aortic aneurysm
Surgery
Treatment Outcome
Female
Core laboratory
Cardiology and Cardiovascular Medicine
business
Aortic Aneurysm, Abdominal
Subjects
Details
- ISSN :
- 10785884
- Volume :
- 54
- Database :
- OpenAIRE
- Journal :
- European Journal of Vascular and Endovascular Surgery
- Accession number :
- edsair.doi.dedup.....95581e318f432792ada07a7d6796a1a1