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RESEARCH PRODUCT

CT Angiography at 24 Months Demonstrates Durability of EVAR With the Use of Chimney Grafts for Pararenal Aortic Pathologies

Mario LachatDieter MayerGiovanni TorselloMartin AustermannStefan PuchnerZoran RancicThomas PfammatterFelice PecoraroTheodosios BisdasKonstantinos P. Donas

subject

Malemedicine.medical_specialtyTime Factorsmedicine.medical_treatmentAortic Diseases610 Medicine & healthEndovascular aneurysm repair2705 Cardiology and Cardiovascular MedicineAortic aneurysmAneurysmmedicine.arterymedicineHumans2741 Radiology Nuclear Medicine and ImagingRadiology Nuclear Medicine and imagingAorta AbdominalEmbolizationSuperior mesenteric arteryAgedendovascular aneurysm repair chimney graft periscope graft pararenal aortic pathologies aortic aneurysm para-anastomotic aneurysm ruptured aneurysm stent-graft balloon-expandable stent-graft computed tomographic angiography endoleak renal arteries superior mesenteric artery sac shrinkage sac expansionmedicine.diagnostic_test10042 Clinic for Diagnostic and Interventional Radiologybusiness.industryEndovascular ProceduresAngiographyPerioperativemedicine.diseaseBlood Vessel Prosthesis10020 Clinic for Cardiac Surgery2746 SurgerySurgeryCuffAngiographyFemaleStentsSurgeryRadiologyTomography X-Ray ComputedCardiology and Cardiovascular MedicinebusinessFollow-Up Studies

description

PURPOSE: To present the 24-month radiological follow-up data for patients with pararenal aortic pathologies treated with chimney and periscope grafts during endovascular repair. METHODS: Between January 2008 and December 2011, 124 high-risk patients with complex pararenal aortic pathologies were treated using the chimney technique at 2 European vascular and cardiovascular centers with advanced experience of the described technique. In particular, 50 patients were treated at Site 1 and 74 at Site 2. Forty (32.2%) patients (32 men; mean age 79.2±4.9 years) completed computed tomographic angiography follow-up at 24 months postoperatively. RESULTS: The overall technical success was 100%, and the early- and midterm procedure-related mortality was 0%. Three (2.4%) patients had a perioperative type Ia endoleak that persisted; two were treated by transbrachial perigraft embolization and cuff implantation. The last patient is under radiological surveillance due to a "low-flow" type Ia endoleak and stable sac size. A type II endoleak was detected in 7 (5.6%) patients. During the 2-year follow-up, significant shrinkage (>5 mm; n=22) or stable aneurysm diameter (n=14) was seen in 36 (90%) of the cases. Overall, mean aneurysm sac shrinkage was 12% (p=0.002) and 10% (p=0.014) for the 2 centers, respectively (overall p=0.008). The causes for sac progression in the 4 (10%) patients were a type Ia endoleak, 2 type II endoleaks, and endotension. CONCLUSION: The present study demonstrates that the use of chimney and/or periscope endografts for pararenal aortic pathologies achieves and maintains successful exclusion of the aneurysm in 90% of the cases at 24 months of radiological follow-up. In centers experienced with this approach, the chimney technique may represent a reliable therapeutic modality in selected patients.

yearjournalcountryeditionlanguage
2013-01-01Journal of Endovascular Therapy
https://doi.org/10.1583/12-4029.1