title: Endovascular Aneurysm Sealing (EVAS) and Chimney EVAS in the Treatment of Failed Endovascular Aneurysm Repairs.
abstract: To assess the technical success and clinical outcome of reinterventions using the Nellix Endovascular Aneurysm Sealing (EVAS) System to treat complications after endovascular aneurysm repair (EVAR).
  
  
  
  Fifteen consecutive patients (mean age 79 years; 14 men) with prior EVAR were treated with EVAS between March 2014 and December 2015 at 2 institutions. The failed prior EVARs included 13 bifurcated endografts, 1 bifurcated graft plus fenestrated cuff, and 1 tube endograft. Endoleaks were the predominant indications: type Ia in 10 and type III in 5 (3 type IIIa and 2 type IIIb). All patients presented with progressive aortic aneurysms (median 7.85-cm diameter; range 6.5-11). Eight patients were treated on an urgent or emergency basis (6 symptomatic aneurysms and 2 contained ruptures). All patients underwent Nellix relining of the failed stent-graft; 10 had chimney (Ch) procedures in combination with EVAS (chEVAS) because the proximal landing zones were inadequate.
  
  
  
  Technical success was 100%. All endoleaks were successfully sealed, and no additional intervention was required. No further endoleak after EVAS or chEVAS was recorded. Endobag protrusion occurred in 1 case without sequelae. One elderly patient with ruptured aneurysm died from multiple organ failure 2 months postoperatively. One renal artery guidewire injury led to nephrectomy because of active bleeding. No reinterventions, aneurysm-related mortalities, graft thrombosis, endoleaks, or chimney graft occlusions were observed during a median follow-up of 8 months (range 3-24).
  
  
  
  The present preliminary experience demonstrates that the use of EVAS/chEVAS is feasible for treatment of failed EVAR. This technique may be used as bailout or an alternative treatment when other established methods are infeasible or not available.
authors: 1 Department of Cardiothoracic and Vascular Surgery, Medical Center of the Johannes Gutenberg-University Mainz, Germany.
authors: Marwan
authors: M
authors: Youssef
authors: 2 Department of Vascular Surgery, Hospital of Augsburg, Germany.
authors: Sebastian
authors: S
authors: Zerwes
authors: 2 Department of Vascular Surgery, Hospital of Augsburg, Germany.
authors: Rudolf
authors: R
authors: Jakob
authors: 1 Department of Cardiothoracic and Vascular Surgery, Medical Center of the Johannes Gutenberg-University Mainz, Germany.
authors: Oroa
authors: O
authors: Salem
authors: 1 Department of Cardiothoracic and Vascular Surgery, Medical Center of the Johannes Gutenberg-University Mainz, Germany.
authors: Fritz
authors: F
authors: Dünschede
authors: 1 Department of Cardiothoracic and Vascular Surgery, Medical Center of the Johannes Gutenberg-University Mainz, Germany.
authors: Christian F
authors: CF
authors: Vahl
authors: 1 Department of Cardiothoracic and Vascular Surgery, Medical Center of the Johannes Gutenberg-University Mainz, Germany.
authors: Bernhard
authors: B
authors: Dorweiler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D000072226:Computed Tomography Angiography; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012086:Reoperation; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D017211:Treatment Failure
keywords: abdominal aortic aneurysm; chimney grafts; endoleak; endovascular aneurysm repair; endovascular aneurysm sealing