Endograft (VORTEC) reconstruction of aortic branches allowing endovascular treatment of aortic aneurysm.

Chimney and Periscope Grafts Observed Over 2 Years After Their Use to Revascularize 169 Renovisceral Branches in 77 Patients With Complex Aortic Aneurysms

Purpose: To evaluate the performance of periscope and/or chimney grafts (CPGs) in the endovascular treatment of pararenal or thoracoabdominal aneurysms using off-the-shelf devices. Methods: Between February 2002 and August 2012, 77 consecutive patients (62 men; mean age 7369 years) suffering from pararenal aortic (n¼55), thoracoabdominal (n¼16), or arch to visceral artery aneurysms (n¼6) were treated with aortic stent-graft implantation requiring chimney and/or periscope grafts to maintain side branch perfusion. CPGs were planned in advance and were not used as bailout. A standardized follow-up protocol including computed tomographic angiography, laboratory testing, and clinical examination…

Periscopes, chimneys, sandwich and VORTEC to facilitate abdominal and thoracoabdominal aortic aneurysm repair

The VORTEC (VIABAHN open revascularization technique) and the chimney graft technique are tools with which to maintain or restore blood flow to the aortic branches and can be used intentionally or as a bailout procedure in open surgery or endovascular procedures. VORTEC is a stent graft-based vascular connection technique that achieves end-to-end anastomosis configuration; it is especially useful when the traditional suture technique proves (can be) cumbersome. It is also a speedy tool with virtually no blood flow interruption and no anastomotic bleeding, and patency rates compare favorably with sutured anastomosis. The chimney/periscope, as well as the sandwich graft technique (CHIMPES), i…

Chimney endografting for pararenal aortic pathologies using transfemoral access and the lift technique

Purpose: To present a technique for transfemoral implantation of parallel grafts into the renal arteries in patients with anatomy or morphology that blocks standard antegrade chimney graft delivery. Technique: In a totally percutaneous approach, a 5-F pigtail angiographic catheter is passed into the aorta above the renal arteries via a 0.035-inch hydrophilic guidewire, followed by an 8-F sheath. The target vessel is cannulated with the hydrophilic wire followed by a 5-F reverse curve catheter; the wire is changed for a Rosen wire. The main stent-graft body is delivered and parked at the level of the aortic bifurcation. The Viabahn chimney endograft is advanced ~1 to 2 cm into the target ren…

A clampless and sutureless aortic anastomosis technique using an endograft connector for aortoiliac occlusive disease in which the aorta cannot be clamped or sewn due to calcification or scarring

Bypass surgery in aortoiliac or aortofemoral occlusive disease can be technically demanding and hazardous due to huge calcifications and/or patient co-morbidities. We report about mid-term results of a telescoping sutureless aortic anastomosis technique using endografts as connectors to address such challenging situations. This is a single-center experience (2004–2011) in seven patients (63 ± 6 years) requiring aortoiliac (three) or aortofemoral (four) bypass surgery. In six cases, an aortic stent graft was telescoped into the infrarenal aorta and partly deployed within the aorta and partly outside the aorta. In the first case, a bifurcated stent graft was deployed and the iliac legs were p…

Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair.

Purpose: To present early and midterm results of the periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving zone 3. Methods: From April 2010 to January 2013, 14 consecutive high-risk patients (11 men; mean age 7068 years, range 56–87) underwent TEVAR with the PG technique for 10 thoracic aortic aneurysms (TAA), 2 traumatic aortic ruptures, and 2 aortic dissections without a suitable landing zone (.2 cm distal to the LSA). Five procedures were performed emergently for rupture (3 TAAs and the 2 trauma cases). Two patients had a periscope deployed in an aberrant right subclavian artery. The periscope endo…