Background: Due to recent advances in endograft design and percutaneous access, technical success could be increased during endovascular aneurysm repair (EVAR). Beside EVAR, endovascular aneurysm sealing (EVAS) provides an alternative procedure to treat aneurysms. To compare the two methods, additional benchmark criteria should be evaluated: Screening time, dose area product (DAP), procedure time and contrast use. In this study these technical variables are analysed for EVAS vs. EVAR in comparable patient cohorts.
Methods: It is a retrospective, single-centre study. Only elective cases of infrarenal aortic aneurysms were included, all treated by the same surgeon (D.B.). Procedures were performed within the instructions for use without additional procedures. All operations were undertaken in a hybrid operating theatre. For EVAR, only the Medtronic Endurant® and the Gore C3 Excluder® were included. For EVAS the Nellix® from Endologix was used.
Results: Between 2012 and 2016, 67 patients were treated with EVAS and 40 with EVAR; of these 20 and 16 could be introduced into the study respectively. Median age was 73 and 72 years respectively (only men). The two groups were comparable in terms of BMI, GFR and ASA-status. Screening time was reduced for EVAS (10,6 vs. 14,5 min., p<0,01), while the DAP was not significantly different. Procedural time and contrast use were increased for EVAS (120 vs. 96 min., 120 vs. 79 ml, p<0,01).
Conclusions: Especially the younger EVAS-procedure requires ongoing review in order to further reduce contrast agent. Reduced screening time for EVAS does not have a significant impact on radiation dose.
Endovascular Aneurysm Sealing Is Associated With Reduced Radiation Exposure and Procedure Time Compared With Standard Endovascular Aneurysm RepairGA Antoniou et al. J Endovasc Ther 23 (2), 285-9. PMID 26850739.EVAS is associated with reduced radiation exposure and operating room usage compared with EVAR, which may have safety and financial implications.
Endovascular Aortic Sealing With Nellix Reduces Intraoperative Radiation Dose When Compared to Endovascular Aortic RepairS Ockert et al. J Vasc Surg 67 (4), 1068-1073. PMID 29032904.EVAS is associated with a relevant decrease in indirect measured radiation dose and time of procedure compared with standard EVAR. A relevant reduction in dose during EVA …
Endovascular Aneurysm Sealing and Chimney Endovascular Aneurysm Sealing in the Treatment of Type Ia and Type III Endoleaks After Endovascular Aneurysm RepairF Lareyre et al. Ann Vasc Surg 61, 317-325. PMID 31394252.EVAS and chimney EVAS in the treatment of type Ia and type III endoleaks after EVAR and chimney EVAR are technically feasible. Short-term follow-up suggests that the proc …
The Nellix Endovascular Aneurysm Sealing System: Current PerspectivesXY Choo et al. Med Devices (Auckl) 12, 65-79. PMID 30858738. - ReviewReported outcomes of EVAS are acceptable. Type I endoleak, sac enlargement, device migration, and aneurysm rupture are recognized complications. High-level research is re …
Clinical Outcomes After Nellix Endovascular Aneurysm SealingA Holden. Semin Vasc Surg 29 (3), 102-105. PMID 27989314. - ReviewThe published evidence on clinical outcomes of Nellix Endovascular Aneurysm Sealing for elective abdominal aortic aneurysm repair has confirmed low procedural morbidity a …
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Initial Experience and Potential Advantages of AFX2 Bifurcated Endograft System: Comparative Case SeriesE Jo et al. Vasc Specialist Int 35 (4), 209-216. PMID 31915665.Our preliminary experiences with selected AAA patients treated using the AFX2 endovascular repair system showed good outcomes compared with similar patients treated using …