Innovative solutions for endovascular aneurysm sealing—delayed Nellix type 1a endoleak

A delayed Nellix (Endologix, Irvine, Calif) type 1a endoleak from endovascular aneurysm sealing (EVAS) is particularly challenging to treat owing to the restrictions and scarcity of the technical options available. We have described two viable endovascular solutions, with and without the availability of the Nellix endograft inventory. A Nellix-in-Nellix apparatus with multivisceral chimney, covered stent extensions and internal reinforcements can be used if Nellix endografts are available (patient 1). In the absence of Nellix endografts, we used a Viabahn-in-Nellix apparatus, also with multiple chimney stents, as an alternative and timely treatment for patient 2. Our patients remained well and free of endoleaks at 19 and 11 months after treatment.