A new study shows that chimney grafts during endovascular aneurysm repair (EVAR) offers first-rate long-term stent-graft patency and stable aneurysms.
Researchers at St. Franziskus Hospital (Münster, Germany), University Hospital Zürich (Switzerland), and other institutions conducted a study to examine radiological follow-up data of 124 high-risk patients with complex pararenal aortic pathologies treated with chimney and periscope grafts during EVAR between January 2008 and December 2011 in two European sites. In all, 50 patients were treated in one site, and 74 at the other; of these, 40 patients completed computed tomography (CT) angiography follow-up at 24 months postoperatively.
The results showed that the overall technical success was 100%, with no procedure-related mortality; three (2.4%) patients had a perioperative type Ia endoleak that persisted. A type II endoleak was detected in seven (5.6%) patients. During the 2-year follow-up, significant shrinkage or stable aneurysm diameter was seen in 36 (90%) of the cases. Overall, mean aneurysm sac shrinkage was 12% and 10% for the two centers, respectively. The causes for sac progression in four (10%) of the patients were a type Ia endoleak, 2 type II endoleaks, and endotension. The study was published in the February 2013 issue of the Journal of Endovascular Therapy.
“The use of chimney and/or periscope endografts for pararenal aortic pathologies achieves and maintains successful exclusion of the aneurysm in 90% of the cases at 24 months of radiological follow-up,” concluded lead author Konstantinos Donas, MD, PhD, of St. Franziskus Hospital, and colleagues. “In centers experienced with this approach, the chimney technique may represent a reliable therapeutic modality in selected patients.”
When important branch vessels are involved in the aneurysm, covering them can lead to serious problems with major organs, such as the kidneys and intestines. A treatment to address this problem involves placing a chimney graft—a covered stent—between the aortic endograft and the aortic wall. The chimney graft begins in the undiseased aorta and runs parallel to the aortic stent-graft, ending at the opening of a covered branch vessel, delivering blood to the vessel and the organ it supplies.
St. Franziskus Hospital
University Hospital Zürich