Use of abdominal chimney grafts is feasible and safe: short-term results.
Title | Use of abdominal chimney grafts is feasible and safe: short-term results. |
Publication Type | Journal Article |
Year of Publication | 2010 |
Authors | Donas, K. P., Torsello G., Austermann M., Schwindt A., Troisi N., & Pitoulias G. A. |
Journal | J Endovasc Ther |
Volume | 17 |
Issue | 5 |
Pagination | 589-93 |
Date Published | 2010 Oct |
ISSN | 1545-1550 |
Keywords | Aged, 80 and over, Aortic Aneurysm, Abdominal, Aortography, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation, Endoleak, Endovascular Procedures, Feasibility Studies, Germany, Graft Occlusion, Vascular, Humans, Kaplan-Meier Estimate, Male, Prosthesis Design, Reoperation, Stents, Thrombectomy, Time Factors, Tomography, X-Ray Computed, Treatment Outcome |
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. |
DOI | 10.1583/10-3083.1 |
Alternate Journal | J. Endovasc. Ther. |
PubMed ID | 20939713 |