Use of abdominal chimney grafts is feasible and safe: short-term results.

Abstract

PURPOSE:

To present our initial experience with the use of chimney grafts in endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) with challenging anatomy.

METHODS:

Among 390 EVAR cases performed at our institution between November 2008 and February 2010, 15 patients (all men; mean age 81.8 years) underwent EVAR with synchronous placement of chimney grafts. The chimney technique involved placing covered stents parallel to the main aortic stent-graft to preserve or rescue flow to aortic branch vessels while extending the proximal fixation zone. All patients presented with pararenal aortic aneurysms with short necks (between 0 and 10 mm long) that required either suprarenal clamping to tailor a proximal anastomosis in open repair or suprarenal fixation to anchor an endoprosthesis. Chimney grafts were implanted into 10 left renal and 5 right renal arteries.

RESULTS:

The immediate technical success was 100%. One early type II endoleak due to retrograde flow from the inferior mesenteric artery was detected and is under surveillance. Mean follow-up was 6.8 months (range 1-13). One chimney graft occluded 45 days postoperatively; the patient underwent open thrombectomy of the left renal artery and iliorenal bypass. The creatinine value at discharge was 1.6 mg/dL, and resting renal scintigraphy showed 36% perfusion for the left kidney and 64% for the right kidney. During follow-up, no patient required hemodialysis; no aneurysm-related deaths were noted.

CONCLUSION:

This limited experience demonstrates that the use of abdominal chimney grafts is feasible and safe. Long-term results in larger patient cohorts are needed evaluate the utility of this alternative endovascular technique.

• Authors: Konstantinos P Donas, Giovanni Torsello, Martin Austermann, Arne Schwindt, Nicola Troisi, Georgios A Pitoulias
• Journal: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (J Endovasc Ther) Vol. 17 Issue 5 Pg. 589-93 (Oct 2010) ISSN: 1545-1550 [Electronic] United States
• PMID: 20939713 (Publication Type: Journal Article)

Topics

• Aged, 80 and over
• Aortic Aneurysm, Abdominal (diagnostic imaging, surgery)
• Aortography (methods)
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation (adverse effects, instrumentation)
• Endoleak (etiology, surgery)
• Endovascular Procedures (adverse effects, instrumentation)
• Feasibility Studies
• Germany
• Graft Occlusion, Vascular (etiology, surgery)
• Humans
• Kaplan-Meier Estimate
• Male
• Prosthesis Design
• Reoperation
• Stents
• Thrombectomy
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome