Early Study Supports Feasibility of Endovascular Sealing of Ruptured AAAs Using the Endologix Nellix Device

July 13, 2015—Findings from a study conducted to assess the feasibility of and report preliminary results of ruptured abdominal aortic aneurysm (rAAA) repair with endovascular aneurysm sealing (EVAS) were published by Jorg L. de Bruin, MD, et al in the Journal of Endovascular Therapy (JEVT; 2015:22:283–287). The investigators noted that EVAS is a novel therapeutic alternative whose feasibility has not been established in rAAAs because of the unknown effects of the rupture site on the ability to achieve sealing.

As summarized in JEVT, between December 2013 and April 2014, five patients (median age, 71 years, range, 57–90; three men) with rAAAs were treated with the Nellix EVAS system (Endologix) at a single institution, St. George’s Vascular Institute at St. George’s University Hospitals NHS Foundation Trust in London, United Kingdom.

The investigators reported that median aneurysm diameter was 70 mm (range, 67–91). Aneurysm morphology in four of the five patients was noncompliant with instructions for use (IFU) for both EVAS and standard stent grafts. The remaining patient had anatomy that was outside the IFU for standard stent grafts but was treated with EVAS under standard IFU for the Nellix system. Median Hardman index was 2 (range, 0–3). Two patients died of multiorgan failure after relaparotomy and intraoperative cardiac arrest, respectively. Among survivors, all devices were patent with no signs of endoleak or failed aneurysm sac sealing at 6 months (median follow-up, 9.2 months).

EVAS for the management of infrarenal rAAAs appears feasible, and the use of EVAS in emergency repairs may broaden the selection criteria of the current endovascular strategy to include patients with more complex aneurysm morphology, concluded the investigators in JEVT.