images Vol. 5, No. 1; 2021; pp 75–76
DOI: 10.26676/jevtm.v5i1.191

Corresponding author:

David T McGreevy, MD, Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, SE-701 85 Örebro, Sweden.


© 2021 CC BY 4.0 – in cooperation with Depts. of Cardiothoracic/Vascular Surgery, General Surgery and Anesthesia, Örebro University Hospital and Örebro University, Sweden



Embolization of Type 1 Endoleak Due to Migration of Nellix Endograft System: Clinical Photos of Interest

Tal M Hörer MD PhD1,2 and David T McGreevy MD1

1Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital and University, Sweden

2Department of Surgery Faculty of Medicine and Health, Örebro University Hospital and University, Sweden



Keywords: Nellix; Embolization; Endoleak; Rupture

Received: 18 February 2021; Accepted: 25 February 2021




An 85-year-old male patient, 3 years after Nellix endograft implantation due to abdominal aortic aneurysm, presented to the clinic for annual follow-up with a huge endoleak secondary to aneurysm expansion and Nellix endograft migration. In order to prevent a rupture of the aortic aneurysm, and as the patient was not a candidate for open surgery, the endoleak was sealed with Ruby Coils (Penumbra, Alameda, USA) and Onyx (Medtronic, Santa Rosa, CA). Figure 1 shows the endoleak on computed tomography (CT; arrows mark the endoleaks). Figure 2ac shows the angiography procedure with Ruby Coils and Onyx filling the endoleak space. Figure 3a,b shows the post-operative CT. The endoleak diminished on post-operative CT and was not detected by contrast enhanced ultrasound and the patient is planned for follow-up. Tight follow-up is recommended as this is a rescue procedure that we have used in several patients but long-time follow-up is unknown. This method has been used in symptomatic and ruptured aortic aneurysms with different endograft configurations.


Figure 1

Ethics Statement

(1)  All the authors mentioned in the manuscript have agreed to authorship, read and approved the manuscript, and given consent for submission and subsequent publication of the manuscript.

(2)  The authors declare that they have read and abided by the JEVTM statement of ethical standards including rules of informed consent and ethical committee approval as stated in the article.

Conflict of Interest

The authors declare that they have no conflicts of interest.


Figure 2


Figure 3


The authors received no financial support for the research, authorship, and/or publication of this article.

Author Contributions

TMH and DTM drafted, wrote and revised the manuscript.