Collected Transatlantic Experience From the PERICLES Registry: Use of Chimney Grafts to Treat Post-EVAR Type Ia Endoleaks Shows Good Midterm Results

Ronchey, Silvia; Fazzini, Stefano; Scali, Salvatore T.; Torsello, Giovanni; Kubilis, Paul; Veith, Frank J.; Donas, Konstantinos P.; Pecoraro, Felice; Mangialardi, Nicola

doi:10.1177/1526602818782941

Cited by 19 publications

(8 citation statements)

References 39 publications

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“…Thirty-day operative mortality was 2.6%, with a 7.7% all-cause mortality at a mean follow-up of nearly two years. 10 These results suggest that Ch-EVAR could be considered a good treatment option (when compared with open surgical conversion) for this difficult group of patients.…”

Section: Summary Of the Published Evidence On Chimney Evar From The Pmentioning

confidence: 84%

“…evaluated 39 patients from the PERICLES registry who were treated for type IA endoleaks that occurred after a previous infrarenal EVAR. 10 They noted a technical success rate of 89.7%, with a 7.6% risk of persistent type IA endoleak at 30 days and a primary chimney stent patency of 94.3% at 36 months. Thirty-day operative mortality was 2.6%, with a 7.7% all-cause mortality at a mean follow-up of nearly two years.…”

Section: Summary Of the Published Evidence On Chimney Evar From The Pmentioning

confidence: 96%

“…Furthermore, iterative analyses from the registry brought into sharper focusing on other noteworthy applications of Ch-EVAR such as the remediation of type 1A endoleak after standard infrarenal EVAR. 10 Ronchey et al. evaluated 39 patients from the PERICLES registry who were treated for type IA endoleaks that occurred after a previous infrarenal EVAR.…”

Section: Summary Of the Published Evidence On Chimney Evar From The Pmentioning

confidence: 99%

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Current role of the chimney technique in the treatment of complex abdominal aortic pathologies: A position paper from the PERICLES Registry investigators

et al. 2020

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Section: Summary Of the Published Evidence On Chimney Evar From The Pmentioning

confidence: 84%

Section: Summary Of the Published Evidence On Chimney Evar From The Pmentioning

confidence: 96%

Section: Summary Of the Published Evidence On Chimney Evar From The Pmentioning

confidence: 99%

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Current role of the chimney technique in the treatment of complex abdominal aortic pathologies: A position paper from the PERICLES Registry investigators

et al. 2020

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“…7–9,14 Furthermore, chEVAR could be advised in the post-EVAR setting to treat type Ia endoleaks. 23 Newer alternatives, including physician-modified endovascular grafts and in situ fenestration, seem promising; however, supportive literature is still scarce. 24–27 Therefore, these treatment alternatives are typically considered only when other treatments options are lacking.…”

Section: Discussionmentioning

confidence: 99%

Gutter Characteristics and Stent Compression of Self-Expanding vs Balloon-Expandable Chimney Grafts in Juxtarenal Aneurysm Models

et al. 2020

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Purpose: To assess in silicone juxtarenal aneurysm models the gutter characteristics and compression of different types of chimney graft (CG) configurations. Materials and Methods: Fifty-seven combinations of Excluder C3 or Conformable Excluder stent-grafts (23, 26, and 28.5 mm) were deployed in 2 silicone juxtarenal aneurysm models with 3 types of CGs: Viabahn self-expanding (VSE; 6 and 13 mm) or Viabahn balloon-expandable (VBX; 6, 10, and 12 mm) stent-grafts and Advanta V12 balloon-expandable stent-grafts (ABX; 6 and 12 mm). Setups were divided into 4 groups on the basis of increasing CG and main graft (MG) diameters. Two independent observers assessed gutter size and type as well as CG compression on computed tomography scans using postprocessing software. Results: In the smaller diameter combinations (6-mm CG and 23-, 26-, and 28.5-mm MGs), both VSE (p=0.006 to 0.050) and ABX (p=0.045 to 0.050) showed lower gutter areas and volumes compared with VBX. In turn, the VBX showed a nonsignificant tendency to decreased compression, especially compared to ABX. Use of the Excluder C3 showed a 6-fold increase in type A1 gutters (related to type Ia endoleak) as compared to the Conformable Excluder (p=0.018). Balloon-expandable stent-grafts (both ABX and VBX) showed a 3-fold increase in type A1 gutters in comparison with self-expanding stent-grafts (p=0.008). Conclusion: The current study suggests that use of the Conformable Excluder in combination with VSE chimney grafts is superior to the other tested CG/MG combinations in terms of gutter size, gutter type, and CG compression.

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“…In this setting, chimney graft (CG) and relining remain an acceptable alternative to treat selected cases. 4 According to experiences shown in literature, the use of the endoanchors with chimney technique can improve the procedure results in primary EVAR, especially in distal migration risk cases. 5 , 6 We show a proximal relining with mono renal chimney and simultaneous endoanchors implant in treatment of late IaEL in two cases.…”

Section: Introductionmentioning

confidence: 99%

Chimney technique with endoanchors in treatment of late type 1a endoleak after endovascular aortic repair

Gatta

Pagliariccio

Schiavon

et al. 2020

SAGE Open Medical Case Reports

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The late type Ia endoleak after endovascular aortic repair could be a challenging issue. Over the last years, in case of short or enlarged neck, fenestrated and branched stent grafts have been increasingly employed with improving results. However, these devices have limited use in urgent/emergent cases as custom graft manufacturing takes long time, and may not be fit in patients with particular anatomic features. In this setting, chimney and relining remain an alternative but sometimes may not be adequate. According to literature, the use of the endoanchors associated to chimney technique can improve the procedure results in primary endovascular aortic repair. We treated two patients with a late type Ia endoleak after endovascular aortic repair with a simultaneous relining, single renal chimney, and endoanchors implant. These patients were valuated unfit for open repair with neck configuration unadapt for a simple relining, ballooning, or stenting. The patient conditions were unfavorable for an endovascular repair with branched endovascular aortic repair–fenestrated endovascular aortic repair. The same procedure was performed in both patients. Postoperative angio-computed tomographic scan demonstrated the resolution of the endoleak with patency of renal graft. Our preliminary experience, in these selected cases, demonstrate the feasibility of the technique in late type Ia endoleak.

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Collected Transatlantic Experience From the PERICLES Registry: Use of Chimney Grafts to Treat Post-EVAR Type Ia Endoleaks Shows Good Midterm Results

Abstract: The present series demonstrates that chEVAR in the treatment of post-EVAR type Ia endoleaks has satisfactory results independent of the abdominal and chimney graft combinations. Midterm results show that chEVAR is an effective method for treating type Ia endoleaks.

Cited by 19 publications

References 39 publications

Current role of the chimney technique in the treatment of complex abdominal aortic pathologies: A position paper from the PERICLES Registry investigators

Current role of the chimney technique in the treatment of complex abdominal aortic pathologies: A position paper from the PERICLES Registry investigators

Gutter Characteristics and Stent Compression of Self-Expanding vs Balloon-Expandable Chimney Grafts in Juxtarenal Aneurysm Models

Chimney technique with endoanchors in treatment of late type 1a endoleak after endovascular aortic repair

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