Martinelli Ombretta, Fresilli Mauro, Irace Luigi, Venosi Salvatore, Jabbour Jihad, Picone Veronica, Maruca Debora, Di Girolamo Alessia, Gossetti Bruno
Department of Vascular and Endovascolar Surgery, Policlinico "Umberto I" Hospital, Rome, Italy.
Department of Vascular and Endovascolar Surgery, Policlinico "Umberto I" Hospital, Rome, Italy.
Ann Vasc Surg. 2018 May;49:316.e5-316.e10. doi: 10.1016/j.avsg.2017.12.020. Epub 2018 Mar 1.
To report the use of a Nellix endovascular aneurysm sealing (EVAS) device, to successfully treat a type Ia endoleak (EL) after an endovascular aortic repair (EVAR).
A 70-year-old man was diagnosed with a 90-mm aortic aneurysm, suspicious for being inflammatory. It was initially treated successfully, with a Medtronic Endurant (Medtronic, Minneapolis, MN, USA). Five years after the index endovascular repair, an asymptomatic type Ia EL was detected on duplex ultrasound and computed tomographic angiogram. Other endovascular solutions in the form of proximal cuff, chimney was considered difficult to execute due to challenges in planning, manipulation, and renal cannulation caused by the short proximal sealing zone above the existing stent graft and the constraints of the previous endograft. Thus, a relining of the previous endoprothesis was performed using the Nellix system (Endologix, Inc., Irvine, CA, USA). One-year follow-up imaging demonstrated successful resolution of the EL and persistent sealing of the Nellix device.
Nellix EVAS system can be an alternative and safe option for relining a stent graft with a type Ia EL. Nellix platform can be added to the clinician's armamentarium for treating type Ia EL after conventional EVAR of infrarenal abdominal aortic aneurysm (AAA).
报告使用Nellix血管内动脉瘤封堵（EVAS）装置成功治疗血管内主动脉修复（EVAR）术后Ia型内漏（EL）的情况。
一名70岁男性被诊断患有90毫米的主动脉瘤，怀疑为炎性。最初使用美敦力Endurant（美敦力公司，明尼阿波利斯，明尼苏达州，美国）成功治疗。在初次血管内修复术后五年，经双功超声和计算机断层血管造影检测到无症状的Ia型EL。由于现有支架移植物上方近端密封区短以及先前腔内移植物的限制，导致在规划、操作和肾插管方面存在挑战，因此认为以近端袖带、烟囱形式的其他血管内解决方案难以实施。于是，使用Nellix系统（Endologix公司，尔湾，加利福尼亚州，美国）对先前的腔内假体进行了内衬。一年的随访成像显示EL成功消失，Nellix装置持续密封。
Nellix EVAS系统可以作为一种替代且安全的选择，用于对伴有Ia型EL的支架移植物进行内衬。Nellix平台可以添加到临床医生治疗肾下腹主动脉瘤（AAA）传统EVAR术后Ia型EL的武器库中。
