Dinoto E, Ferlito F, Mirabella D, Tortomasi G, Bajardi G, Pecoraro F
Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy.
Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy.
Int J Surg Case Rep. 2021 Jun;83:106024. doi: 10.1016/j.ijscr.2021.106024. Epub 2021 May 26.
Endovascular aneurysm sealing (EVAS) with the Nellix system was introduced to reduce endovascular aneurysm repair (EVAR) perioperative complications, especially endoleaks. Herein we report a case of successful type 1A endoleak managed with detachable coils embolization after EVAS.
A 77-year-old male was referred for abdominal pain. The angio-CT scan confirmed the previous EVAS procedure and showed a type Is2 endoleak below the right renal artery resulting in a 2.5 cm aortic blister with contrast medium filling the space between the aortic wall and the endobags. The patient was considered unfit for conventional open surgery and an endovascular approach with coil embolization Concerto Helix Detachable Coil System was chosen under local anesthesia. After intervention, a complete abdominal pain regression was registered. The 12- month CT follow-up showed endoleak sealing and Nellix system stability.
EVAS has been associated to a high endoleaks and complications incidence when compared to EVAR. The EVAS different device concept led to a different endoleak classification and management. Endoleak management main options include the Nellix system explantation or the Nellix in Nellix application, however these are nearly always not applicable, respectively, due to the high surgical risk condition and the Nellix system availability, especially in emergent setting. Despite the use of coil embolization is controversial, this tool is off-the-shelf and leads to a disease resolution in most of patients without other surgical options.
Proximal type Is2 embolization after EVAS is feasible with limited invasiveness.
采用Nellix系统进行血管内动脉瘤封闭术（EVAS），旨在减少血管内动脉瘤修复术（EVAR）围手术期并发症，尤其是内漏。在此，我们报告1例EVAS术后采用可脱卸弹簧圈栓塞成功处理1A型内漏的病例。
一名77岁男性因腹痛前来就诊。血管造影CT扫描证实了之前的EVAS手术，并显示右肾动脉下方存在I型s2内漏，导致主动脉出现一个2.5厘米的水泡，造影剂填充在主动脉壁与内袋之间的间隙。该患者被认为不适合进行传统的开放手术，遂在局部麻醉下选择采用Concerto Helix可脱卸弹簧圈系统进行血管内弹簧圈栓塞治疗。干预后，腹痛完全消退。12个月的CT随访显示内漏封堵及Nellix系统稳定。
与EVAR相比，EVAS的内漏和并发症发生率较高。EVAS不同的装置理念导致了不同的内漏分类和处理方式。内漏处理的主要选择包括取出Nellix系统或在Nellix系统内再植入Nellix系统，然而，由于手术风险高以及Nellix系统的可用性，尤其是在紧急情况下，这些方法几乎总是不适用。尽管使用弹簧圈栓塞存在争议，但该工具现成可用，并且在大多数没有其他手术选择的患者中能使疾病得到解决。
EVAS术后近端I型s2栓塞具有可行性，且侵袭性有限。
