P-013 - MID-TERM EVALUATION OF THE EVAS SYSTEM: REINTERVENTIONS AFTER EVAS AND MANAGEMENT OF COMPLICATIONS

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Kuntz S. (Department of Vascular Surgery ~ Lausanne ~ Switzerland) , Justine L. (Department of Vascular Surgery ~ Lausanne ~ Switzerland) , Longchamp A. (Department of Vascular Surgery ~ Lausanne ~ Switzerland) , Trunfio R. (Department of Vascular Surgery ~ Lausanne ~ Switzerland) , Cote E. (Department of Vascular Surgery ~ Lausanne ~ Switzerland) , Deslarzes-Dubuis C. (Department of Vascular Surgery ~ Lausanne ~ Switzerland) , Deglise S. (Department of Vascular Surgery ~ Lausanne ~ Switzerland)
Introduction:
The Nellix EndoVascular Aneurysm Sealing (EVAS) System was associated with poor mid- and long-term outcomes, especially due to distal stents migration with type Ia endoleak and limb occlusion leading to the temporary device withdrawal from the market. The study aim was to report long-term Nellix EVAS outcomes and the management of the associated complications, espcially device failures.
Methods:
A monocentric retrospective review of prospective data from Secutrial database concerning EVAS procedures was performed. Patient were followed using standardized protocol with angiological examns and angio-CT scans. Device failure was defined as a triad of stent migration, stent separation, and secondary sac expansion, or any intervention for type 1endoleak, device rupture, or explant. Outcomes were 30-day mortality rate, overall mortality rate and re-intervention rate.
Results:
A total of 50 (men n=43, women n=7) patients was treated with Nellix EVAS between March 2013 and December 2016, with 100% technical success. Mean age was 77,0 (SD ± 7,0) years. Median follow up was 3,05 (IQR, 0,52 - 4,63) years and the follow up index was 0,51 (IQR 0,10 - 0,88). Overall 30-day mortality for all comers was 0 %, overall mortality during the follow-up period was 30% and aneurysm related mortality during follow up was 13 %. Kaplan-Meier estimate of freedom from all-cause mortality at 72 months was 30,2%. There were 17 (34 %) device failures in the cohort. Thirteen (26%) patients required at least one re-intervention. Six patients underwent limb extension, 2 underwent EVAR-in-Nellix procedure, 2 required embolization, 3 had stent angioplasty, 2 underwent branched thoraco-abdominal devices and 5 underwent surgical conversion with device explantation through laparotomy and aortic bypass.
Conclusion:
Our cohort confirmed already reported poor long-term outcomes of the EVAS, associated with multiple reinterventions. Long-term follow-up is therefore mandatory. Management of the complications should be done in aortic center as many techniques are required to adapt to the patients and his anatomy. Open repair and device explantation should be offered to fit patients. In unfit patients, complex endovascular repair using ChEVAR or F/BEVAR remains a technical demanding option but an adequate solution.