Endovascular Aneurysm Sealing and Chimney Endovascular Aneurysm Sealing in the Treatment of Type Ia and Type III Endoleaks After Endovascular Aneurysm Repair.

Background: The aim of this study was to report the treatment of type Ia and type III endoleaks after endovascular aneurysm repair (EVAR) or chimney EVAR using endovascular aneurysm sealing (EVAS) and chimney EVAS.

Methods: Ten consecutive patients who underwent the EVAS procedure to treat endoleaks after EVAR were retrospectively included between July 2015 and July 2017. Technical success of EVAS was defined as a successful sealing of the Nellix endograft with visceral vessel patency on intraoperative completion angiography.

Results: The median time between EVAR and EVAS procedure was 41.5 months (29-81.8). Eight patients had an elective procedure, whereas 2 were treated in emergency. Chimney endografts were placed during the EVAS procedure in 4 patients, whereas classic EVAS was performed for the other 6 patients. The median procedural time was 222.5 min (138.8-418.8). The technical success was achieved for all patients. The median length of stay after EVAS was 7 days (6.8-14). No death related to abdominal aortic aneurysms or vascular complications were reported for a median follow-up duration of 13.5 months (6.3-25.5). A reintervention was required for 2 patients who developed persistent type II and type Ia endoleaks, which were successfully treated using an embolization procedure.

Conclusions: 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 procedure is a safe and efficient therapeutic alternative to manage disabled EVAR.