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J Cardiovasc Surg (Torino). 2017 May 26. doi: 10.23736/S0021-9509.17.09899-8. [Epub ahead of print]

Aortic aneurysm endovascular treatment with the parallel graft technique from the aortic arch to the iliac axis.

Author information

1
Vascular and Endovascular Surgery Unit, Department of Surgery, San Francesco Hospital, Nuoro, Italy.
2
Vascular and Endovascular Surgery Unit, Department of Surgery, San Francesco Hospital, Nuoro, Italy - kasemiholta@libero.it.
3
Vascular Surgery Unit, Department of Surgery, Cardinal Panico Hospital, Tricase, Lecce, Italy.
4
Cardiology Unit, Department of Cardiovascular Disease, Tor Vergata University of Rome, Rome, Italy.
5
Vascular and Endovascular Surgery Unit, Department of Medicine, Surgery and Neurological Sciences, University of Siena, Siena, Italy.

Abstract

BACKGROUND:

The chimney technique has been developed for the treatment of complex aortic aneurysms. We analyzed the midterm to long-term outcomes of this approach from a single- centre experience.

METHODS:

From October 2008 to July 2016, 58 patients underwent endovascular aortic aneurysm repair using the chimney technique. Indications for treatment were thoracic aortic aneurysm (TAA) (n = 11), thoracoabdominal aortic aneurysm (TAAA) (n = 2), pararenal aortic aneurysm (PAAA) (n= 15), aortoiliac/isolated hypogastric artery aneurysm (n = 25), type I endoleak after previous TEVAR/EVAR (n=4), proximal pseudoaneurysm after AAA open repair (n = 1). Elective (82.8%) and emergent (17.2%) procedures were included.

RESULTS:

The immediate technical success was 100%. Single, double and triple chimneys were performed in 46, 10 and 2 patients, respectively. Overall, 61 target vessels (3 left common carotid arteries, 8 left subclavian arteries, 3 celiac trunks, 3 superior mesenteric arteries, 19 renal arteries and 25 hypogastric arteries) were involved. Post-operative mortality was 0. No neurologic complications were registered. Primary patency rate of the chimney stent/stent graft was 98.3%. Low flow type I endoleak was observed in 4 patients (6.9%). Post-operative chimney graft re-intervention rate was 1.7%. The median follow up was 32±20 months (range 3- 96 months). Overall estimated survival at 12, 50 and 80 months was 100%, 89% and 44%, respectively. Estimated freedom from endoleak at 1, 12, 24 and 36 months was 96.5%, 95%, 95% and 93%, respectively. One HA stent graft occluded at the 3rd month of follow up. No reintervention was performed.

CONCLUSIONS:

Our experience with the chimney technique for aortic aneurysms from the aortic arch to the iliac axis shows promising and durable mid- and long term results. Endograft oversizing, associated with the chimney graft diameter and length choice remain fundamental to reduce the risk of the most frequent procedure complications: type I endoleak and CG occlusion.The wider use of this technique should be justified in patients considered at high risk for open repair and/or not suitable for the custom-made branched/fenestrated endografts.

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