Feasibility and Technical Aspects of Proximal Nellix-in-Nellix Extension for Late Caudal Endograft Migration
| Autor: | Clark J. Zeebregts, Esmé J. Donselaar, Michel M.P.J. Reijnen, Andrew Holden, Aleksandra C. Zoethout |
|---|---|
| Přispěvatelé: | Man, Biomaterials and Microbes (MBM), Vascular Ageing Programme (VAP) |
| Rok vydání: | 2016 |
| Předmět: |
Male
Models Anatomic medicine.medical_specialty Endoleak Computed Tomography Angiography 030204 cardiovascular system & hematology Prosthesis Design Aortography 03 medical and health sciences Aortic aneurysm Blood Vessel Prosthesis Implantation 0302 clinical medicine Aneurysm Foreign-Body Migration medicine Humans Radiology Nuclear Medicine and imaging 030212 general & internal medicine Nellix-in-Nellix technique Aged Netherlands endovascular aneurysm sealing Aged 80 and over proximal extension business.industry Endovascular Procedures Models Cardiovascular Angiography Digital Subtraction endograft medicine.disease Surgery Blood Vessel Prosthesis Treatment Outcome stent-graft migration Feasibility Studies Female Stents Cardiology and Cardiovascular Medicine business aortic aneurysm SYSTEM Aortic Aneurysm Abdominal New Zealand |
| Zdroj: | Journal of Endovascular Therapy, 24(2), 210-217. SAGE Publications Inc. |
| ISSN: | 1545-1550 1526-6028 |
| Popis: | Purpose: To describe the feasibility and technical aspects of a proximal Nellix-in-Nellix extension to treat caudal stent-graft migration after endovascular aneurysm sealing (EVAS) in the in vitro and in vivo settings. Methods: In vitro studies were designed (1) to assess inner diameters of Nellix-in-Nellix extensions after postdilation with 12-mm balloons and (2) to test wall apposition in tubes with different diameters using a Nellix-in-Nellix stent-graft that extended out of the original Nellix stent-graft lumen by 10, 20, 30, and 40 mm. Simulated-use experiments were performed using silicone models in conjunction with a pulsatile flow pump. In the clinical setting, 5 patients (median age 74 years, range 73–83) presented at 2 centers with type Ia endoleak secondary to caudal Nellix stent-graft migration measuring a median 9 mm (range 7–15) on the left and 7 mm (range 0-11) on the right. Median polymer fill volume at the initial EVAS procedure was 42.5 mL (range 25–71). The median time to reintervention with a proximal Nellix extension was 15 months (range 13–32). Results: In vitro, the inner diameters of the Nellix-in-Nellix extensions were consistent after postdilation. Cases with 10 and 20 mm of exposed endobag resulted in a poor seal with endoleak, while cases with 30 and 40 mm of exposed endobag length exhibited angiographic seal. Fill line pressures of the second Nellix were higher than expected. In the 5 clinical cases, chimney grafts were required in each case to create an adequate proximal landing zone. The Nellix-in-Nellix procedure was successful in all patients. There were no procedure-related complications, and no endoleaks were observed during a median 12-month follow-up. Reinterventions were performed in 2 patients because of in-stent stenosis and chimney graft compression, respectively. Conclusion: Proximal Nellix-in-Nellix extension can be used to treat caudally migrated Nellix stent-grafts and to treat the consequent type Ia endoleak, but the technique differs from primary EVAS. The development of dedicated proximal extensions is desirable. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|