Transhepatic Embolization of Bilateral Pulmonary Artery Aneurysm with N-Butyl Cyanoacrylate and Coils in Behçet Disease

With the Nellix EVAS (Endologix), which is currently under investigational use (1), fixation and seal are not provided by the aneurysmal neck, but by the aneurysm sac itself and aortic wall lining. As previously described (2) ,t he covered cobalt-chromium endoframe of the device is surrounded by an empty endobag, which is filled with a solidifying biostable polymer that acts as an anchor, thereby fixating the stent and effectively sealing the aneurysm. As the polymer is injected in the endobags in a liquid state, the endobags adapt to the configuration of the aneurysmal neck. When cured, the polymer shapes the endobag according to the local anatomy without endoleaks. Because of the altered fixation concept, the endograft offers a new perspective for the endovascular treatment of hostile necks (3), as described in the present case. The case presented here shows the feasibility and technical success of abdominal aneurysm exclusion with the Nellix EVAS in a patient with a severely eccentric calcification in the infrarenal neck that would be otherwise unsuitable for endovascular repair. Open reconstructive surgery is the preferred method of treatment in patients with hostile aortic morphology. However, the patient described here was deemed unfit for open repair. Safe use of the Nellix device in patients with these eccentric calcified necks has not been described in the current investigational trial of the device to our knowledge. Further investigation and clinical experience is required to verify the safety of the device, especially in terms of the sturdiness of the endobag during polymer filling. The concept of the Nellix EVAS offers the potential for a broader indication for endovascular aneurysm repair.