St. George's 30-Day EVAS Outcomes Published

August 6, 2015—A study conducted at St. George's Vascular Institute at St George’s Hospital, in London, United Kingdom, evaluated 105 patients with infrarenal abdominal aortic aneurysms (AAA) treated with endovascular aneurysm sealing (EVAS. Jack R.W. Brownrigg, MBChB, et al published the 30-day outcomes in the European Journal of Vascular and Endovascular Surgery (EJVES; 2015;50:157–164).

The investigators present the early clinical experience, technical refinements, and learning curve of EVAS in the treatment of AAA at their institution using the Nellix EVAS system (Endologix). EVAS had been proposed as a novel alternative to endovascular aneurysm repair in patients with infrarenal AAA, they noted.

As summarized in EJVES, the investigators recorded prospective data on the 105 consecutive patients who were treated with EVAS between March 2013 and November 2014 at St. George's Vascular Institute. Collected data included demographics, preoperative aneurysm morphology, and 30-day rates of endoleak, limb occlusion, reintervention, and death. Postoperative imaging consisted of duplex ultrasound and computed tomographic angiography.

The mean age of the cohort was 76 ± 8 years, and 12% were female. Adverse neck morphology was present in 72 (69%) patients, including aneurysm neck length < 10 mm (20%), neck diameter > 32 mm (18%), β-angulation > 60° (21%), and conical aneurysm neck (51%). 

The investigators reported that there was one death within 30 days. The incidence of type I endoleak within 30 days was 4% (n = 4); all were treated successfully with transcatheter embolization. The four proximal endoleaks were associated with technical issues that resulted in procedure refinement, and all were in patients with adverse proximal aortic necks. The rate of persistent type I endoleak at 30 days was 0%, and there were no type II or type III endoleaks. Angioplasty and adjunctive stenting were performed for postoperative limb stenosis in three patients (3%).

The publication's conclusion was that EVAS appears to be associated with reasonable 30-day outcomes despite the necessity of procedural evolution in the early adoption of this technique. EVAS appears to be applicable to patients with challenging aortic morphology, and endoleak rates should reduce with procedural experience. The utility of EVAS will be defined by the durability of the device in long-term follow-up, although the absence of type II endoleaks is encouraging, stated the investigators in EJVES.

“We are excited by the potential for Nellix and will continue to follow up patients in a lifelong surveillance programme,” Prof. Ian Loftus said in comments to Endovascular Today. “We now have experience of over 200 cases and will be looking at mid- and long-term outcomes in due course, which will be important for such a novel technology.”