Endovascular Aneurysm Sealing (EVAS) Alone or in Combination with Chimney Grafts (chEVAS) for Treating Complications of Previous Endovascular Aneurysm Repair (EVAR) Procedures

Objective: Late complications after previous endovascular aneurysm repair (EVAR) procedures include type I/III endoleaks causing aneurysm growth and rupture. We reviewed our results from the management of such complications with endovascular aneurysm sealing (EVAS) techniques. Methods: Analysis of our prospectively maintained aneurysm database was performed (December 2013–May 2017). Primary outcomes were: (1) success of the procedure in excluding the primary complication, (2) perioperative mortality, (3) post-operative complications and (4) survival. Results: Ten consecutive patients were treated for complications of EVAR procedures performed 2–12 years previously. All patients underwent EVAS with/without chimney grafts for 6 type Ia,1 type IIIb and 3 undetermined (but presumed type IIIb) endoleaks. Overall, 19 Nellix^® devices were used. The technical success with type Ia endoleaks was 100%. All sealed using proximal extension through chimney EVAS with 1 target vessel loss. There were no perioperative deaths. All but 1 type Ia endoleak remained eliminated at follow-up (range 2–29 months) as did the proven type IIIb endoleak. Two of the 3 undetermined endoleaks demonstrated continued sac expansion requiring surgical exploration by laparotomy, during which type II endoleaks were identified. Conclusions: EVAS provides effective short-term treatment of type Ia/IIIb endoleaks after EVAR. However, late complications may occur due to disease progression. Level of Evidence: Level 4, case series.