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RESEARCH PRODUCT
Multiple periscope and chimney grafts to treat ruptured thoracoabdominal and pararenal aortic aneurysms
Mario LachatThomas FrauenfelderZoran RancicThomas PfammatterDimitri PapadimitriouDieter MayerLukas HechelhammerFelice PecoraroFelice PecoraroFrank J. VeithFrank J. Veithsubject
AdultMalemedicine.medical_specialtyTime Factorsmedicine.medical_treatmentAortic RuptureLess invasive610 Medicine & healthRuptured Aortic AneurysmProsthesis DesignEndovascular aneurysm repairSettore MED/22 - Chirurgia VascolareAortography2705 Cardiology and Cardiovascular Medicinelaw.inventionBlood Vessel Prosthesis ImplantationlawmedicineHumans2741 Radiology Nuclear Medicine and ImagingRadiology Nuclear Medicine and imagingChimneyAgedRetrospective Studiesendodebranching renovisceral arteries chimney graft periscope graft stentgraft endograft ruptured aortic aneurysm ruptured thoracoabdominal aortic aneurysm ruptured pararenal aortic aneurysm ruptured AAA endovascular aneurysm repairAged 80 and overAortic Aneurysm Thoracicbusiness.industry10042 Clinic for Diagnostic and Interventional RadiologyEndovascular ProceduresChimney graftBlood flowMiddle AgedSurgeryBlood Vessel Prosthesis10020 Clinic for Cardiac Surgery2746 SurgeryTreatment Outcomecardiovascular systemSurgeryFemaleStentsRadiologyPeriscopeCardiology and Cardiovascular MedicinebusinessTomography X-Ray ComputedAortic Aneurysm Abdominaldescription
Purpose: To report midterm outcomes after urgent endovascular repair of ruptured pararenal or thoracoabdominal aortic aneurysms using multiple periscope and chimney grafts to preserve renovisceral branch perfusion and facilitate aneurysm exclusion. Methods: Nine consecutive men (mean age 72614 years, range 40–88) presenting with ruptured thoracoabdominal (n56), pararenal (n52), or infrarenal (n51) aortic aneurysm underwent urgent endovascular repair with at least 1 periscope graft delivered via a transfemoral access; chimney grafts were installed from an axillary access. In all, 17 periscope and 7 chimney grafts were used to reperfuse 11 renal and 13 visceral arteries in the 9 patients. The aortic aneurysms were excluded using thoracic devices (n57), an aortic extension cuff (n51), and bifurcated stent-grafts (n52). Results: All procedures were completed without technical complications except for a dislocated stent-graft from the right renal artery; the artery could not be re-accessed, and the right kidney was sacrificed. One patient died of multiple organ failure (11% 30-day mortality). At a mean follow-up of 10 months (range 3–24), 5 of the 9 patients had recovered completely; 3 patients died of unrelated causes. Imaging showed no aneurysm growth in any patient, with a mean 20% shrinkage in aneurysm size. All periscope and chimney grafts remained patent, and no aortic stent-graft migration was observed. Renal function and the glomerular filtration rate remained stable in all patients. Conclusion: The periscope and chimney graft technique provides a simpler, less invasive way to maintain blood flow to the renovisceral arteries during urgent endovascular aortic repairs. The very low 30-day mortality rate and the stability of the repairs in the midterm are encouraging. This technique has the potential to profoundly influence the treatment of acute aortic pathologies.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2011-10-01 |