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  • Title: Endovascular Aneurysm Sealing (EVAS) Alone or in Combination with Chimney Grafts (chEVAS) for Treating Complications of Previous Endovascular Aneurysm Repair (EVAR) Procedures.
    Author: Paraskevas KI, Karouki M, Rehman A, Torella F, McWilliams RG, England A, Fisher RK.
    Journal: Cardiovasc Intervent Radiol; 2018 Jul; 41(7):1015-1020. PubMed ID: 29725808.
    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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