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Case Reports
. 2019 Nov 22;5(4):576-579.
doi: 10.1016/j.jvscit.2019.10.004. eCollection 2019 Dec.

Late failure of a Nellix endoprosthesis treated with the t-Branch off-the-shelf multibranched stent graft

Antonio Lorido  1 , Matteo Orrico  1 , Mario Marino  1 , Alessio Vona  1 , Sonia Ronchey  1 , Nicola Mangialardi  1
Affiliations
Case Reports

Late failure of a Nellix endoprosthesis treated with the t-Branch off-the-shelf multibranched stent graft

Antonio Lorido et al. J Vasc Surg Cases Innov Tech. .

Abstract

A 66-year-old man arrived at our emergency department 3 years after an endovascular aneurysm sealing procedure performed at another center. Computed tomography angiography showed distal migration of a Nellix endoprosthesis (Endologix, Irvine, Calif) and a posterior contained rupture. The left kidney was excluded by an occluded iliac-left renal bypass, which was performed at the time of the Nellix implantation because of unintended coverage. A t-Branch (Cook Medical, Bloomington, Ind) was implanted in an emergency, but the delivery caused disruption of the Nellix limb, requiring relining. Target vessels were bridged with VBX stents (W. L. Gore & Associates, Flagstaff, Ariz). The postoperative course was uneventful except for renal function impairment that was restored 2 weeks later.

Keywords: BEVAR; EVAS; Nellix; Type IA endoleak; t-Branch.

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Figures

Fig 1
Fig 1
A, Preoperative three-dimensional volume rendered image showing Nellix failure with type I endoleak from associated proximal evolution and endobag distal migration. B, Evidence of abdominal aortic aneurysm (AAA) contained rupture at L3 level and the occluded left renal bypass in a preoperative cross-sectional image.
Fig 2
Fig 2
A, The t-Branch device is delivered inside the Nellix endograft. B, The t-Branch device is released proximal to the right Nellix endobag.
Fig 3
Fig 3
Postoperative three-dimensional volume rendered image showing the correct t-Branch positioning with the branches' iliac axis patency and aneurysm exclusion.
See this image and copyright information in PMC

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