6533b859fe1ef96bd12b786b
RESEARCH PRODUCT
Collected World Experience About the Performance of the Snorkel/Chimney Endovascular Technique in the Treatment of Complex Aortic Pathologies
K. P. DonasJ. T. LeeM. LachatG. TorselloF. J. VeithR. L. DalmanK. TranF. PecoraroT. BisdasS. SeifertM. EscheD. GaspariniP. FrigattiR. AdovasioF. P. MucelliS. M. DamrauerE. Y. WooA. BeckS. ScaliD. MinionJ. SaleniusV. SuominenN. MangialardiS. RoncheyS. FazziniG. MestresV. RiambauN. J. Mosquerasubject
RegistrieMalemedicine.medical_treatmentKaplan-Meier EstimateGlobal HealthSettore MED/22 - Chirurgia VascolareSeverity of Illness IndexEndovascular aneurysm repairAortic aneurysmRetrospective StudieStentRegistriesAbdominal aortic aneurysm; Endovascular; Fenestrated; Thoracoabdominal; Vascular; Aortic Aneurysm Abdominal; Aortography; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Europe; Female; Follow-Up Studies; Global Health; Humans; Kaplan-Meier Estimate; Male; Prosthesis Design; Prosthesis Failure; Retrospective Studies; Risk Assessment; Severity of Illness Index; Stents; Survival Rate; Treatment Outcome; United States; Blood Vessel Prosthesis; RegistriesEndovascularmedicine.diagnostic_testMedicine (all)Endovascular ProceduresAbdominal aortic aneurysmAortic AneurysmProsthesis FailureEuropeSurvival RateBlood Vessel ProsthesiTreatment OutcomeFemaleStentsHumanUnited Statemedicine.medical_specialtyAortographyProsthesis DesignAortographyRisk AssessmentFenestratedFollow-Up StudieBlood Vessel Prosthesis ImplantationBlood vessel prosthesisVascularmedicineHumansAbdominalSurvival rateRetrospective StudiesEndovascular Procedurebusiness.industryRetrospective cohort studymedicine.diseaseUnited StatesBlood Vessel ProsthesisSurgeryAbdominal aortic aneurysm; Endovascular; Fenestrated; Thoracoabdominal; Vascular; Aortic Aneurysm Abdominal; Aortography; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Europe; Female; Follow-Up Studies; Global Health; Humans; Kaplan-Meier Estimate; Male; Prosthesis Design; Prosthesis Failure; Retrospective Studies; Risk Assessment; Severity of Illness Index; Stents; Survival Rate; Treatment Outcome; United States; Blood Vessel Prosthesis; Registries; Surgery; Medicine (all)Abdominal aortic aneurysmSurgeryThoracoabdominalbusinessAortic Aneurysm AbdominalFollow-Up StudiesAbdominal surgerydescription
OBJECTIVES: We sought to analyze the collected worldwide experience with use of snorkel/chimney endovascular aneurysm repair (EVAR) for complex abdominal aneurysm treatment. BACKGROUND: EVAR has largely replaced open surgery worldwide for anatomically suitable aortic aneurysms. Lack of availability of fenestrated and branched devices has encouraged an alternative strategy utilizing parallel or snorkel/chimney grafts (ch-EVAR). METHODS: Clinical and radiographic information was retrospectively reviewed and analyzed on 517 patients treated by ch-EVAR from 2008 from 2014 by prearranged defined and documented protocols. RESULTS: A total of 119 patients in US centers and 398 in European centers were treated during the study period. US centers preferentially used Zenith stent-grafts (54.2%) and European centers Endurant stent-grafts (62.2%) for the main body component. Overall 898 chimney grafts (49.2% balloon expandable, 39.6% self-expanding covered stents, and 11.2% balloon expandable bare metal stents) were placed in 692 renal arteries, 156 superior mesenteric arteries (SMA), and 50 celiac arteries. At a mean follow-up of 17.1 months (range: 1-70 months), primary patency was 94%, with secondary patency of 95.3%. Overall survival of patients in this high-risk cohort for open repair at latest follow-up was 79%. CONCLUSIONS: This global experience represents the largest series in the ch-EVAR literature and demonstrates comparable outcomes to those in published reports of branched/fenestrated devices, suggesting the appropriateness of broader applicability and the need for continued careful surveillance. These results support ch-EVAR as a valid off-the-shelf and immediately available alternative in the treatment of complex abdominal EVAR and provide impetus for the standardization of these techniques in the future.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2015-01-01 | Annals of Surgery |