Preliminary outcome of Nellix-in-Nellix extensions in patients treated with failed endovascular aneurysm sealing

Aleksandra Charlotte Zoethout*, Sebastian Zerwes, Clark J.A.M. Zeebregts, Jan M.M. Heyligers, Jean Paul J.M. De Vries, Alexander Oberhuber, Thomas Karl, Patrick Berg, Kate Stenson, Ian Loftus, Francesco Torella, Piotr Szopiński, Eric Zimmermann, Andrew Holden, Alexander Hyhlik-Duerr, Michel M.P.J. Reijnen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

14 Citations (Scopus)


Background: The 1-year results of the use of the Nellix (Endologix Inc, Irvine, Calif) endovascular aneurysm sealing (EVAS) device were initially promising. However, midterm complications including migration and aneurysm growth occurred more frequently than expected, which provided an incentive to refine the instructions for use. Strategies for the management of complications arising after endovascular aneurysm repair are often not applicable for EVAS, given the unique configuration of the Nellix device, and new techniques are needed. This study analyzes the clinical outcomes of both elective and emergency deployment of a new Nellix device within a primarily placed device, for failure of EVAS, which we refer to as a Nellix-in-Nellix application (NINA). Methods: This is a global, retrospective, observational cohort study focusing on the early outcome of NINA for failed EVAS, including data from 11 European institutions and 1 hospital in New Zealand. Results: A total of 41 patients were identified who underwent a NINA procedure. Of these, 32 (78%) were placed electively and 9 (22%) were placed on an emergency basis. Seven patients were initially treated with chimney EVAS (n = 5 in the elective NINA group and n = 2 in the emergency NINA group). The average time between the primary EVAS procedure and NINA was 573 days (interquartile range, [IQR] 397-1078 days) and 478 days (IQR, 120-806) for the elective and emergency groups, respectively. The indication for elective NINA was endoleak with migration (50%), endoleak without migration (25%), migration without endoleak (16%), and other (9%). Chimney grafts were used in 21 of 32 patients in the elective group and 3 of 9 patients in the emergency group. Technical success was achieved in 94% of patients in the elective group and 100% of patients in the emergency group. At latest follow-up (median, 104 days; IQR, 49-328 days), there were three aneurysm-related deaths (9%), no ruptures, and five device-related reinterventions (16%) within the elective group. In the emergency group (median follow-up, 23 days; IQR, 7-61 days), there were four aneurysm-related deaths and three aneurysm-related reinterventions. Conclusions: In conclusion, a NINA can be used to treat late failures of EVAS with an acceptable technical success rate and can be used when more established treatment options are unfeasible or contraindicated. The durability of this technique needs to be further reviewed.

Original languageEnglish
Pages (from-to)1099-1106
Number of pages8
JournalJournal of vascular surgery
Issue number4
Early online date29 Mar 2019
Publication statusPublished - Oct 2019


  • Abdominal aortic aneurysm
  • Endovascular aneurysm repair
  • Endovascular aneurysm sealing
  • Vascular surgery
  • n/a OA procedure


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