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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2016 October;57(5):730-6

lingua: Inglese

Chimney technique in combination with a sac-anchoring endograft for juxtarenal aortic aneurysms: technical aspects and early results

Maarten K. DINKELMAN 1, Simon P. OVEREEM 2, Dittmar BOCKLER 3, Jean P. DE VRIES 2, Jan M. HEYLIGERS 1

1 Department of Vascular Surgery, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands; 2 Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; 3 Department of Vascular and Endovascular Surgery, Ruprecht-Karls University, Heidelberg, Germany


BACKGROUND: Juxtarenal aortic aneurysms (JAAs) pose clinical challenges for vascular specialists. Chimney endovascular sealing (Ch-EVAS) might be an ideal endovascular solution in the treatment of JAAs. We present technical aspects and early clinical results of a multicenter experience with Ch-EVAS.
METHODS: This was a retrospective, multicenter study. Between November 2014 and March 2016, 16 patients underwent elective endovascular repair of JAAs with Ch-EVAS of 1 or 2 renal and/or superior mesenteric artery vessels. Essential technical steps, early complications, chimney stent patency, gutter formation, type IA endoleak, 30-day outcome, renal function, and neck characteristics were the endpoints.
RESULTS: There were 26 chimney stents implanted with 100% technical success. The intraoperative death and 30 day mortality was 0%. Secondary interventions were required in 3 patients each due to type IA endoleak, limb occlusion and brachial dissection. The latter patient presented with renal chimney stent occlusion and required hemodialysis. One patient was known to have a pulmonary malignancy and left-sided carotid stenosis and sustained a left hemispheric stroke after the endovascular procedure. The preoperative median aortic neck length was 3 mm, after Ch-EVAS the median seal length between endobags and the aortic neck was 25 mm. No further significant changes in neck morphology were found at the one-month follow-up.
CONCLUSIONS: Ch-EVAS is an off-the-shelf solution to treat JAAs with high technical success. Longer-term follow-up with a substantial number of patients can answer the question of whether Ch-EVAS is a sustainable technique that is preferred over open surgery or fenestrated endovascular aneurysm repair.

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