van den Ham Leo H, Ter Mors Thijs G, Boersen Johannes T, de Vries Jean Paul P M, Vriens Patrick W, Heyligers Jan M, Reijnen Michel M P J
Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
Ann Vasc Surg. 2018 Feb;47:223-229. doi: 10.1016/j.avsg.2017.07.038. Epub 2017 Sep 12.
The Nellix endovascular aneurysm sealing (EVAS) system is an alternative endovascular treatment option for infrarenal aortic aneurysms (AAAs), with a unique appearance on computed tomography angiography (CTA). Normal evolution of post-EVAS CTA appearance follow-up is still largely unknown and important to timely detect eventual complications. The objective is to assess the normal appearance of CTA images 30 days and 1 year after EVAS in 50 consecutive patients.
Fifty patients treated with Nellix EVAS for an infrarenal AAA were included from 3 hospitals. Using dedicated software, a total of 150 CTA scans were analyzed by predetermined variables per anatomical segment.
Thirty days post-EVAS, there was a slight, but not statistically significant, increase in AAA diameter that returned to the preoperative value after 1 year. A shift in total aortic volume distribution was observed without changing aortic diameter, including a trend toward a decreased thrombus volume (85.6 ± 49.1 mL and 78.8 ± 35.5 mL at 30 days and 1 year, respectively, P < 0.242) and a slight, but statistically significant, increase in polymer volume (68.2 ± 34.1 mL and 71.9 ± 35.2 mL at 30 days and 1 year, respectively, P < 0.001). The β-angle (P = 0.06) and iliac artery angulation (P < 0.001) decreased after implant. The latter returned to its original state after 1 year, whereas the neck straightening remained. Over time, there was a significant decrease in radiodensity in the middle of the polymer-filled endobags with an increase at its edges (P < 0.05). Thrombus radiodensity significantly increased over the first year (P < 0.05). Diameters of the infrarenal neck and common iliac arteries remained unchanged, no endoleaks were observed, and the position of the device was stable.
Change of CT appearance after EVAS is unique, and as such, the judgment of these images requires experience. The appearance of the endobags in respect to volume and radiodensity differ from classic EVAR. Normal changes over time are observed in aortoiliac angulation, volumes, and radiodensities.
内利克斯血管内动脉瘤封堵（EVAS）系统是治疗肾下主动脉瘤（AAA）的一种替代性血管内治疗选择，在计算机断层扫描血管造影（CTA）上有独特表现。EVAS术后CTA表现的正常演变情况在很大程度上仍不为人所知，而及时发现最终并发症很重要。目的是评估连续50例患者在接受EVAS治疗后30天和1年时CTA图像的正常表现。
从3家医院纳入50例接受内利克斯EVAS治疗肾下AAA的患者。使用专用软件，按照每个解剖节段的预定变量对总共150次CTA扫描进行分析。
EVAS术后30天，AAA直径有轻微增加，但无统计学意义，1年后恢复到术前值。观察到主动脉总体积分布发生变化，但主动脉直径未变，包括血栓体积有减小趋势（30天时为85.6±49.1 mL，1年时为78.8±35.5 mL，P<0.242），聚合物体积有轻微但具有统计学意义的增加（30天时为68.2±34.1 mL，1年时为71.9±35.2 mL，P<0.001）。植入后β角（P=0.06）和髂动脉角度（P<0.001）减小。后者在1年后恢复到原来状态，而颈部变直仍然存在。随着时间推移，聚合物填充的内袋中部的放射密度显著降低，边缘处增加（P<0.05）。血栓放射密度在第一年显著增加（P<0.05）。肾下颈部和髂总动脉直径保持不变，未观察到内漏，装置位置稳定。
EVAS术后CT表现的变化是独特的，因此，对这些图像的判断需要经验。内袋在体积和放射密度方面的表现与经典血管内动脉瘤修复术（EVAR）不同。在主动脉髂动脉角度、体积和放射密度方面观察到随时间的正常变化。
