Endovascular Aneurysm Sealing in combination with Chimneys, a solution for AAA with no neck

Introduction: Endovascular Repair of AAA requires minimum neck length and landing zone infrarenal. If no sufficient landing zone is present, fenestrations, scallops or branched grafts can be used. Chimneys or parallel grafts are an alternative which is immediately available. One of the possible sources of an endoleak are gutters between the stent graft and parallel stents for the branches. The Nellix device (Endologix) has a unique design with deployment of polymer-filled EndoBags around the endograft flow lumen filling the aneurysm sac and by this way preventing Endoleaks. Treating the AAA with the Nellix endovascular aneurysm sealing seems to be a solution to avoid gutters and seal the area around the chimney grafts.
Cases: We present 3 cases of pararenal AAA with narrow and angulated necks not suitable for fenestrated grafts. The treatment is with the Nellix endovascular sealing system with covering the renal arteries and SMA which are revascularized with Eventus balloon expandable covered stents. Beside of the femoral access an additional access from one or both subclavian arteries for the chimney stents is necessary. The chimney stents are dilated together with the polymer filling so all the area around the chimneys are filled with the polymer bags. The implantation procedure is safe and the chimneys are patent in the postoperative control.
Conclusion: The combination of Nellix with chimney seem a good solution to avoid gutters and show good immediate results. Mid and long term results have to proof the concept.