Midterm Outcomes With the Nellix Endograft Alone or With Chimneys

Area of Science:

• Vascular Surgery
• Endovascular Repair
• Aortic Aneurysm Treatment

Background:

• Endovascular aneurysm sealing (EVAS) emerged as an innovative alternative to traditional endovascular abdominal aortic aneurysm repair.
• High midterm failure rates led to the market withdrawal of EVAS devices.
• This study evaluates the midterm outcomes of EVAS, including those combined with chimneys (Ch-EVAS).

Purpose of the Study:

• To report the midterm outcomes of patients treated with EVAS alone or with Ch-EVAS.
• To analyze the management of complications associated with EVAS and Ch-EVAS.
• To assess device failure, mortality, and re-intervention rates in EVAS patients.

Main Methods:

• A single-center study included consecutive Nellix implants from 2013 to 2016.
• Primary endpoint: device failure (migration, separation, sac enlargement, rupture, explant, type I endoleak intervention).
• Analysis of overall mortality, aneurysm-related mortality, and re-intervention rates.

Main Results:

• 34% of patients experienced device failure over a median follow-up of 3.05 years.
• Overall and aneurysm-related mortality rates were 30% and 13%, respectively.
• 28% of patients required re-interventions, with complications noted in 17% of EVAS and 42.9% of Ch-EVAS cases.

Conclusions:

• Midterm outcomes for EVAS are unsatisfactory.
• Patients undergoing EVAS require thorough informed consent and frequent surveillance.
• Open repair and device explantation should be considered primary treatment options.