{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T15:58:52Z","timestamp":1765727932075},"reference-count":22,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Zentralbl Chir"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Introduction Endovascular aneurysm sealing (EVAS) was commercially introduced in 2013. The initial results of EVAS were positive, leading to its widespread use. The mid- and long-term reports showed greater than expected rates of migration, which led to a recall of the device. In the present article, we describe our experience in managing type Ia endoleaks and migration occurring with the Nellix system in three different ways: open repair with Nellix explantation, Nellix-in-Nellix application (NINA technique), and the use of the multibranched Colt device originally dedicated to the treatment of thoracoabdominal aneurysms.<\/jats:p><jats:p>\n          Materials and Methods From February 2014 to June 2021, we performed 20 procedures for failed EVAS or ChEVAS (migration, type Ia endoleak, secondary aneurysm rupture). All patients treated for EVAS failure were male, aged 65\u200a\u2013\u200a79.<\/jats:p><jats:p>\n          Results Seven Nellix explantations were performed. Three patients were admitted to our hospital with ruptured aneurysms that occurred 3 weeks to 4 years (mean 124 weeks) after EVAS, and another four with type Ia endoleak. In all but one case, removal of the Nellix system was easy. In two patients, tube grafts were implanted and in the remaining five cases, bifurcated grafts were implanted. In four patients, graft legs were anastomosed with the internal iliac arteries. One patient with secondary aneurysm rupture died from multiorgan failure on the 4th postoperative day. In two cases, transient renal failure was noticed in the perioperative period. All patients were admitted to the intensive care unit for 1 to 4 days (mean 2 days). The mean hospital stay was 9 days. All patients stayed in follow-up (3\u200a\u2013\u200a56 months), but no other complications occurred. Eight patients were treated with the NINA technique: five for distal migration of the Nellix and three for failed\n\t\t\t\t\tChEVAS. Four patients had a NINA procedure performed with three chimneys, three with two and one with one chimney. In one case, two iliac limbs were implanted to avoid kinking of the external iliac arteries. The median hospitalization time after the procedure was 9 days (range 3\u200a\u2013\u200a12). Four patients developed transient acute renal insufficiency in the perioperative period. The follow-up ranged between 4 and 72 months. In one patient, deterioration of preexisting chronic renal insufficiency developed 5 months after the procedure, but dialysis was not required. One patient died from exacerbation of heart failure 7 months after the NINA procedure. The Colt device was implanted in five patients for the treatment of distal migration with type Ia endoleaks. None of the patients developed any signs of spinal cord ischemia. All patients were admitted to the intensive care unit for 1 or 2 days. In two cases, transient acute renal failure was noticed in the perioperative period.\n\t\t\t\t\tThe mean hospital stay was 9 days. All patients remained in follow-up (6\u200a\u2013\u200a22 months). In one case, the occlusion of the celiac trunk branch was found in contrast computed tomography 1 month after implantation of the Colt device, but without any symptoms. No other complications occurred.<\/jats:p><jats:p>\n          Conclusions Normal strategies for the management of complications for late failure of EVAR, including stent-graft extensions, are not suitable after EVAS; therefore, alternatives are necessary. Conversion to open repair carries an extensive burden on the patient, so it is not recommended for patients with high surgical risk. The use of a Nellix-in-Nellix application to treat late failure of EVAS is not within the instructions for use but could be an effective strategy for a type Ia endoleak with or without migration. The use of this technique has been extremely limited since the Nellix system was recalled from the market. The use of the Colt multibranched device may be an alternative option, but due to the small number of patients, this method needs further evaluation.<\/jats:p>","DOI":"10.1055\/a-1644-1650","type":"journal-article","created":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T23:33:39Z","timestamp":1634686419000},"page":"498-505","source":"Crossref","is-referenced-by-count":7,"title":["The Dilemma after Sealing an Endovascular Aortic Aneurysm \u2013 Three Ways Out"],"prefix":"10.1055","volume":"146","author":[{"given":"Eliza","family":"Pleban","sequence":"additional","affiliation":[{"name":"Clinic of Vascular Surgery, Institute of Hematology and Blood Transfusion, Warszawa, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacek","family":"Michalak","sequence":"additional","affiliation":[{"name":"Clinic of Vascular Surgery, Institute of Hematology and Blood Transfusion, Warszawa, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaroslaw","family":"Iwanowski","sequence":"additional","affiliation":[{"name":"Clinic of Vascular Surgery, Institute of Hematology and Blood Transfusion, Warszawa, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piotr","family":"Szopinski","sequence":"additional","affiliation":[{"name":"Clinic of Vascular Surgery, Institute of Hematology and Blood Transfusion, Warszawa, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,10,19]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.jvs.2016.02.053","article-title":"Migration of the Nellix endoprosthesis","volume":"64","author":"A England","year":"2016","journal-title":"J Vasc Surg"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1177\/1526602818766864","article-title":"Two-year outcome of the Nellix endovascular 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Zerwes","year":"2018","journal-title":"J Endovasc Ther"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.jvs.2019.04.482","article-title":"Migration and sac expansion as modes of midterm therapeutic failure after endovascular aneurysm sealing: 295 cases at a single center","volume":"71","author":"K M Stenson","year":"2020","journal-title":"J Vasc Surg"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1007\/s00270-015-1171-7","article-title":"Transcatheter embolisation of proximal type 1 endoleaks following endovascular aneurysm sealing (EVAS) using the Nellix device: technique and outcomes","volume":"38","author":"S Ameli-Renani","year":"2015","journal-title":"Cardiovasc Intervent Radiol"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.jvs.2017.12.060","article-title":"A propensity-matched comparison of fenestrated endovascular aneurysm repair and open surgical repair of pararenal and paravisceral aortic aneurysms","volume":"68","author":"G Tinelli","year":"2018","journal-title":"J Vasc Surg"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/j.jvs.2021.02.03","article-title":"Management of Nellix migration and type Ia endoleak from proximal endovascular aneurysm sealing relining to late open conversion","volume":"74","author":"L Mortola","year":"2021","journal-title":"J Vasc Surg"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1177\/1526602816677037","article-title":"Feasibility and technical aspects of proximal Nellix-in-Nellix extension for late caudal endograft migration","volume":"24","author":"E J Donselaar","year":"2017","journal-title":"J Endovasc Ther"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1055\/s-0036-1571304","article-title":"Endovascular repair of paravisceral aortic aneurysms combining chimney grafts and the Nellix endovascular aneurysm sealing technology (Four-Vessel ChEVAS)","volume":"65","author":"M Youssef","year":"2017","journal-title":"Thorac Cardiovasc Surg"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.jvscit.2019.10.004","article-title":"Late failure of a Nellix endoprosthesis treated with the t-Branch off-the-shelf multibranched stent graft","volume":"5","author":"A Lorido","year":"2019","journal-title":"J Vasc Surg Cases Innov Tech"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1177\/15266028211010469","article-title":"Novel Technique for the Treatment of Type Ia Endoleak After Endovascular Abdominal Aortic Aneurysm Repair","volume":"28","author":"P M Kasprzak","year":"2021","journal-title":"J Endovasc Ther"}],"container-title":["Zentralblatt f\u00fcr Chirurgie - Zeitschrift f\u00fcr Allgemeine, Viszeral-, Thorax- und 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