6533b7ddfe1ef96bd12753f1

RESEARCH PRODUCT

Chimney and periscope grafts observed over 2 years after their use to revascularize 169 renovisceral branches in 77 patients with complex aortic aneurysms

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description

^ ^Purpose: To evaluate the performance of periscope and/or chimney grafts (CPGs) in theendovascular treatment of pararenal or thoracoabdominal aneurysms using off-the-shelfdevices.Methods: Between February 2002 and August 2012, 77 consecutive patients (62 men; meanage 7369 years) suffering from pararenal aortic (n¼55), thoracoabdominal (n¼16), or arch tovisceral artery aneurysms (n¼6) were treated with aortic stent-graft implantation requiringchimney and/or periscope grafts to maintain side branch perfusion. CPGs were planned inadvance and were not used as bailout. A standardized follow-up protocol includingcomputed tomographic angiography, laboratory testing, and clinical examination wasperformed at 6 weeks; 3, 6, and 12 months; and annually thereafter.Results: Technical success was achieved in 76 (99%) patients; 1 branch stent-graft becamedislocated from a renal artery, which could not be re-accessed. Overall, 169 target vessels(121 renal arteries, 30 superior mesenteric arteries, 17 celiac trunks, and 1 inferior mesentericartery) were addressed with the chimney graft configuration in 111 and the periscope graftconfiguration in 58. In total, 228 devices were used for the CPGs: 213 Viabahn stent-grafts and15 bare metal stents. Over a mean 25616 months (range 1–121), 9 patients died of unrelatedcauses. Nearly all (95%) of the patients demonstrated a decreased or stable aneurysm size onimaging; there was a mean 13% shrinkage in aneurysm diameter. Twenty patients hadprimary type I/III endoleaks at discharge; in follow-up, only 3 of these were still present (nosecondary or recurrent endoleaks were noted). Additional endovascular maneuvers wererequired for CPG-related complications in 13 patients from intervention throughout follow-up.Overall, 4 CPGs occluded (98% target vessel patency); no stent-graft migration was observed.Renal function remained stable in all patients.Conclusion: In this series, the use of CPGs has proven to be a feasible, safe, and effective wayto treat thoracoabdominal and pararenal aneurysms with maintenance of blood flow to therenovisceral arteries. Nearly all of the aneurysms showed no increase in diameter over a .2-year mean follow-up, which supports the midterm adequacy of the CPG technique as amethod to effectively revascularize branch vessels with few endoleaks or branch occlusions.J Endovasc Ther. 2013;20:597–605