LATE TYPE 1A ENDOLEAK AFTER EVAS: AN UNIQUE CHALLENGE

Abstract

Endovascular aneurysm sealing (EVAS) using the Nellix system is an alternative method for abdominal aortic aneurysm (AAA) repair. Type 1 endoleaks are not an uncommon complication following conventional endovascular aortic aneurysm repair (EVAR), occurring in up to 10 % of cases. The incidence of these endoleaks following Nellix EVAS was determined to be up to 3,1% in short-term follow-up. Early detection and classification of this issue is crucial to avoid the potential of sac rupture, previously described. As so, we report a successful endovascular treatment of type 1a endoleak, twenty-four months after a Nellix EVAS implantation. An 82 year-old male underwent a Nellix endovascular repair for a 55 mm infra-renal aortic aneurysm in 2014. Final angiography showed successful aneurysm exclusion with no endoleaks. Regular follow-up using computed tomography angiography (CTA) showed a relatively satisfying good stentgraft positioning, no signs of endoleaks and shrinkage of the aneurysm sac. CTA of 2016 showed a new type 1a endoleak associated wit a significant growth of the aneurysm sac. The authors performed prompt embolization of the endoleak with 0,018” detachable coils and Onyx 34. Final angiography showed patency of the endografts with satisfactory exclusion of the endoleak. The incidence and significance of type 1 endoleaks following Nellix EVAS was previously studied in literature, with some cases reported and the natural history of untreated type 1 endoleak after EVAS might lead to sac rupture and death. The embolization of the endoleak with coils and Onyx appears to be a safe and effective management choice to achieve technical and clinical success in the treatment of these cases.

Keywords

• Abdominal aortic aneurysm
• endoleak
• Onyx 34
• EVAS
• Nellix