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Endovascular Aneurysm Sealing (EVAS) Alone or in Combination with Chimney Grafts (chEVAS) for Treating Complications of Previous Endovascular Aneurysm Repair (EVAR) Procedures

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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.

Level of Evidence

Level 4, case series.

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Authors and Affiliations

  1. Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Prescott Street, Liverpool, L7 8XP, UK

    Kosmas I. Paraskevas, Maria Karouki, Adeeb Rehman, Francesco Torella & Robert K. Fisher

  2. Department of Radiology, Royal Liverpool University Hospital, Liverpool, UK

    Richard G. McWilliams

  3. Directorate of Radiography, University of Salford, Salford, UK

    Andrew England

Authors
  1. Kosmas I. Paraskevas
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  2. Maria Karouki
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  3. Adeeb Rehman
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  4. Francesco Torella
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  5. Richard G. McWilliams
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  6. Andrew England
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  7. Robert K. Fisher
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Corresponding author

Correspondence to Kosmas I. Paraskevas.

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Conflict of interest

Prof. McWilliams and Dr. England have received research grants from Endologix. Prof. Torella and Prof. Fisher have received honoraria and research grants and are paid proctors for Endologix.

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Paraskevas, K.I., Karouki, M., Rehman, A. et al. Endovascular Aneurysm Sealing (EVAS) Alone or in Combination with Chimney Grafts (chEVAS) for Treating Complications of Previous Endovascular Aneurysm Repair (EVAR) Procedures. Cardiovasc Intervent Radiol 41, 1015–1020 (2018). https://doi.org/10.1007/s00270-018-1952-x

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  • DOI: https://doi.org/10.1007/s00270-018-1952-x

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