Comparison of Outcomes With Open, Fenestrated, and Chimney Graft Repair of Juxtarenal Aneurysms: Are We Ready for a Paradigm Shift?

Katsargyris, Αthanasios; Oikonomou, Kyriakos; Klonaris, Chris; Töpel, I.; Verhoeven, Eric L.G.

doi:10.1583/1545-1550-20.2.159

Cited by 213 publications

(226 citation statements)

References 48 publications

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“…Among them was the most frequent complication not EL-I but chronic renal impairment (57%), which was not so dramatically reflected in other studies (12%, 12%, 0%) (Katsargyris et al 2013, Moulakakis et al 2012. It is unclear why other studies report less renal impairment among their patients.…”

Section: Figure 21mentioning

confidence: 76%

Impact of Renal Chimney Grafts on Anatomical Suitability for Endovascular Repair in Ruptured Abdominal Aortic Aneurysm

et al. 2015

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Introduction: Open repair of the aorta carries a high risk for morbidity and mortality especially in the elderly population and in patients unfit for major surgery. Endovascular aortic repair is safe, durable and effective when there is adequate proximal and distal sealing zone for the aortic stent graft. Fenestrated and branched stent grafts have made the repair possible for complex but elective cases that do not have an adequate sealing zone. Urgent complex cases and patients with midaortic occlusive diseases do not have any therapeutic alternative if they are not fit for open repair. Chimney graft technique fills this gap and allows the sealing zones for aortic stent graft to be extended as required. The aim of the present thesis is to study the applicability, safety and durability of CG technique in urgent cases with complex lesions in the thoracic and abdominal aorta including the midaortic occlusive diseases. Patients and Methods: All patients who received CG were treated urgently or semi-urgently. The majority of the treated aortic lesions were aneurysms, dissections, pseudoaneurysms, infection, and accidental overstented vital aortic side branches. The median age of all patients was 75 years (IQR, 69-78), of them 32% were female except for the first study where all ten patients were female with midaortic occlusive diseases. The second study evaluated the mid to long-term efficacy and durability of the CG technique in 29 patients with urgent and complex lesions of the thoracic aorta. The third study examined the long-term results of CG in preserving the visceral flow of 51 patients with urgent complex aortic lesions. The fourth study evaluated the CTA images of 206 patients with ruptured abdominal aortic aneurysm. The study measured the applicability of CG in patients for whom standard EVAR was contraindicated because of a short aneurysmal neck. Results:The results showed that CG is applicable and safe for midaortic occlusive diseases with high technical success and patency rate without major adverse effect. The treated patients with thoracic aortic lesions had 14% 30-day mortality, 21% type I endoleak, 7% CG-related mortality, 98% secondary patency and 68% of the aortic lesions shrank significantly. Visceral CG had a 10% 30-day mortality, 6% CG-related mortality, 12% type I endoleak, 93% secondary patency and 63% of the aortic lesions shrank significantly. Twenty-two patients had one renal arteriy sacrificed, 57% of these required permanent renal dialysis. The fourth study proved that CG technique increased the overall suitability for endovascular repair from 34% to 40-46%. Conclusions: Chimney graft seems effective and safe for treating midaortic occlusive diseases in patients unfit for open surgery. The early and mid to long-term results of the CG technique for urgent and complex lesions of the thoracic and abdominal aorta in high-risk patients are promising with a low early mortality, acceptable rate of type I endoleaks and long durability of the CGs, which may justify a broader applicability of this ...

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Section: Figure 21mentioning

confidence: 76%

Impact of Renal Chimney Grafts on Anatomical Suitability for Endovascular Repair in Ruptured Abdominal Aortic Aneurysm

et al. 2015

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“…40 Depending on the definition, JRAs represent almost 15% of all AAAs. 20 SRAs involve the origin of at least one renal artery and include the PRAs, which involve the renal arteries but do not extend into the superior mesenteric artery (SMA), and paravisceral aortic aneurysms, which involve the renal arteries and the SMA, but not the celiac axis. 52 Type IV TAAAs involve the origin of all four visceral arteries including the celiac axis, extending up to the diaphragmatic hiatus.…”

Section: General Criteriamentioning

confidence: 99%

“…In case of small and calcified external iliac arteries, a retroperitoneal approach and an iliac conduit may be required. The PC is introduced in one side (the delivery sheath of the PC has a diameter of 22-24 Fr and a large (20)(21)(22)(23)(24) sheath is inserted on the contralateral side, each over a stiff wire. The latter is positioned just above the aortic bifurcation and after retrieval of the stiff wire three or four smaller sheaths are introduced through the large sheath valve.…”

Section: Details Of the Techniquementioning

confidence: 99%

“…Some designs are without fenestrations but with branches (pre-attached limbs or cuffs) targeted for the visceral aortic vessels, suitable for the endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs). At least for short-necked and juxtarenal aortic aneurysms (JRAs), fenestrated stent-grafting technology has been shown to be feasible, [12][13][14][15][16][17][18][19][20] with published results of highvolume experienced single centers [21][22][23][24][25][26][27][28][29][30][31] and a few recent multicenter trials 32,33 sharing remarkable short-and midterm results, with the durability of the technique being satisfactory (technical success > 95%, low mortality rates averaging 1-2% and low rates of mid-term branch vessel occlusion averaging 4-9%). [25][26][27][28][29]34 Other imaginative procedures have also been developed or modified to allow for the segmental or complete coverage of the aorta in the region of vital branches, including the 'chimney', 'snorkel', 'periscope' [35][36][37] and combined endovascular exclusion and extra-anatomic mesenteric/renal bypasses (hybrid visceral revascularization).…”

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confidence: 99%

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Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm

et al. 2016

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The introduction of fenestrated stent grafts (SGs) to treat abdominal aortic aneurysms (AAAs) with short proximal necks began in 1999. Nowadays, the whole visceral aorta can be treated totally by endovascular means. The established use of fenestrated devices to treat complex AAAs as a first-line management option has been previously reported. An up-to-date evaluation of the literature was performed including all types of publications regarding the use of fenestrated technology to repair complex AAAs. Fenestrated repair is now an established alternative to hybrid/chimney/snorkel repairs. However, specific criteria and prerequisites are required for the use and improvement of this method. Multiple device morphologies have been used incorporating the visceral arteries in various combinations. This modular strategy connects different devices (bridging covered stents and bifurcated SGs) with the aortic main body, thus excluding the aneurysm from the circulation. Precise deployment of the fenestrated SG is mandatory for successful visceral vessel revascularization. Accurate SG sizing and customization, a high level of technical skill, and facilities with modern imaging techniques including 3D road mapping and dedicated hybrid rooms are required. Most experience has been with the custom-made Zenith Cook platform, although off-the-shelf devices have been recently implanted. More complex repairs have been performed over the last few years, but device complexity has also increased. Perioperative, mid-term, and a few recently reported long-term results are encouraging. Secondary interventions remain the main problem, similar to that observed after traditional endovascular abdominal aortic aneurysm repair (EVAR).

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“…Moreover, the occurrences of type I endoleaks were not rare ranging from 7% to 12%. [15][16][17][18] In contrast, a fenestrated stentgraft allows the preservation of more than 3 visceral vessels, i.e., both renal arteries, the SMA, and the celiac artery thereby ensuring the maintenance of stent-graft sealing zones for a long duration. Recent reports from high-volume vascular centers and multi-centers trials iliac leg was kinked and then occluded.…”

Section: Follow-upmentioning

confidence: 99%

Early Experience with Fenestrated Stent Grafts for Treatment of Juxtarenal Aortic Aneurysm

Unno

Yamamoto

Higashiura

et al. 2013

Annals of Vascular Diseases

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Comparison of Outcomes With Open, Fenestrated, and Chimney Graft Repair of Juxtarenal Aneurysms: Are We Ready for a Paradigm Shift?

Cited by 213 publications

References 48 publications

Impact of Renal Chimney Grafts on Anatomical Suitability for Endovascular Repair in Ruptured Abdominal Aortic Aneurysm

Impact of Renal Chimney Grafts on Anatomical Suitability for Endovascular Repair in Ruptured Abdominal Aortic Aneurysm

Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm

Early Experience with Fenestrated Stent Grafts for Treatment of Juxtarenal Aortic Aneurysm

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