Endovascular Repair with Chimney Technique for Juxtarenal Aortic Aneurysm: A Single Center Experience

Ma, Xin; Guo, Wei; ZhongZhou, H.; Li, Xiaoping; Jiang, Xiaolang; Jia, Xin

doi:10.1016/j.ejvs.2014.11.012

Cited by 31 publications

(24 citation statements)

References 19 publications

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“…No strict guidelines exist. Surprisingly, the majority of CGs both visceral 6,7,21,23 and thoracic 27,32,37 were used in elective procedures. This may explain the low 30 day mortality and also implies that CGs were selected in many cases where more established endovascular techniques would have been applicable, including the use of complex custom made stent grafts.…”

Section: Discussionmentioning

confidence: 99%

“…5 Some centers use the CG technique as the treatment of choice even for elective cases. 6,7 Maybe the most important reason for this is that CGs are available off the shelf and are less prohibitively expensive than fenestrated and branched stent grafts. 7,8 The main concern about CGs has been the risk of EL-I due to the so called gutters.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 Maybe the most important reason for this is that CGs are available off the shelf and are less prohibitively expensive than fenestrated and branched stent grafts. 7,8 The main concern about CGs has been the risk of EL-I due to the so called gutters. The gutters are channels that may appear between the CG and the main aortic stent graft.…”

Section: Introductionmentioning

confidence: 99%

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Chimney Grafts in Aortic Stent Grafting: Hazardous or Useful Technique? Systematic Review of Current Data

Lindblad

Jabr

Holst

et al. 2015

European Journal of Vascular and Endovascular Surgery

130

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Increasing amounts of data support the benefit of visceral and arch chimney graft techniques. In particular, the low early mortality and complication rates and high long-term patency seem advantageous; however, the majority of cases have been treated electively, and there is a high risk of bias in all studies. Mid- to long-term data suggest few late complications, except in cases where one renal artery was sacrificed. The CG technique is valuable for complex urgent patients and needs further documentation for other patient groups.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Chimney Grafts in Aortic Stent Grafting: Hazardous or Useful Technique? Systematic Review of Current Data

Lindblad

Jabr

Holst

et al. 2015

European Journal of Vascular and Endovascular Surgery

130

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“…Two studies did not provide aneurysm classification [22,26]. The mean diameter was reported by seven studies and ranged from 50 mm to 74 mm, and the overall mean diameter was 64 mm [11,18,19,[23][24][25]. Forty-five patients were treated in an acute setting (Table 1) [10,12].…”

Section: Patient Demographics and Study Characteristicsmentioning

confidence: 99%

Cerebrovascular Complications After Upper Extremity Access for Complex Aortic Interventions: A Systematic Review and Meta-Analysis

Meertens

Lemmens

Oderich

et al. 2019

Cardiovasc Intervent Radiol

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Purpose The purpose of this study was to review the risk of developing cerebrovascular complications from upper extremity access during endovascular treatment of complex aortic aneurysms. Methods A systematic review and meta-analysis were conducted according to the PRISMA guideline. An electronic search of the public domains Medline (PubMed), Embase (Ovid), Web of Science and Cochrane Library was performed to identify studies related to the treatment of aortic aneurysms involving upper extremity access. Metaanalysis was used to compare the rate of cerebrovascular event after left, right and bilateral upper extremity access. Results are presented as relative risk (RR) and 95% confidence intervals (CIs). Results Thirteen studies including 1276 patients with complex endovascular treatment of aortic aneurysms using upper extremity access were included in the systematic review. Left upper extremity access (UEA) was used in 1028 procedures, right access in 148 and bilateral access in 100 procedures. The rate of cerebrovascular complications for patients treated through left UEA was 1.7%, through right UEA 4% and through bilateral UEA 5%. In the metaanalysis, we included seven studies involving 645 patients treated with a left upper extremity access, 87 patients through a right and 100 patients through a bilateral upper extremity access. Patients, who underwent right-sided (RR 5.01, 95% CI 1.51-16.58, P = 0.008) or bilateral UEA (RR 4.57, 95% CI 1.23-17.04, P = 0.02), had a significantly increased risk of cerebrovascular events compared to those who had a left-sided approach. Conclusion Left upper extremity access is associated with a significantly lower rate of cerebrovascular complications as compared to right or bilateral upper extremity access.

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“…Much of the published experience with chimneys in the setting of EVAR has consisted of small institutional case series. [8][9][10][11][12] However, the results of the Performance of the Chimney Technique for the Treatment of Complex Aortic Pathologies (PERICLES) EVAR registry continue to provide the highest quality evidence for this modality. 13 In this study, Donas et al accumulated 898 chimneys implanted in 517 patients from 2008 to 2014.…”

Section: Discussionmentioning

confidence: 99%

Adjunctive visceral artery chimney in patients undergoing Zenith Fenestrated aortic repair

Wang

Drucker

Dalsing

et al. 2018

Journal of Vascular Surgery

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Objective: Visceral artery chimneys have been employed as an adjunct to endovascular aneurysm repair (EVAR) to treat short-neck infrarenal and juxtarenal aortic aneurysms for more than two decades. With the widespread introduction of fenestrated endovascular aneurysm repair by the Food and Drug Administration-approved Zenith Fenestrated endograft (ZFEN; Cook Medical, Bloomington, Ind) to the United States in 2012, clinicians gained the ability to apply the chimney technique to these custom devices for difficult anatomy. The purpose of this report was to demonstrate feasibility and to provide evidence on the performance of chimneys for the treatment of complex juxtarenal aneurysms that could not be adequately treated with ZFEN alone.Methods: A retrospective analysis was performed of a prospectively maintained institutional ZFEN database capturing 110 fenestrated endovascular aneurysm repairs from October 2012 to January 2018 to identify patients undergoing a concomitant visceral artery chimney. All patients with <12 months of follow-up were excluded from further analysis. Demographic, anatomic, intraoperative, perioperative, and follow-up characteristics were tabulated and analyzed.Results: Six patients met criteria and were included in this investigation. They were universally male with a mean age of 76.2 years at the time of ZFEN/chimney. Chimneys were placed in a total of six visceral arteries (n ¼ 1 per patient) consisting of three renal arteries, two celiac arteries, and one accessory renal artery. Mean estimated blood loss and operative time were 283 mL and 298 minutes, respectively. Technical success was achieved in all cases. Two small type IA "gutter" endoleaks were detected early; both spontaneously resolved on follow-up. We observed no instances of chimney migration, stenosis, or thrombosis perioperatively or on follow-up. Two reinterventions were performed in these six patients; these consisted of a repeated renal stent for ostial stenosis at a main body fenestration and a common femoral artery endarterectomy and patch angioplasty for an access-related common femoral artery occlusion.Conclusions: Use of ZFEN in conjunction with a singular chimney is safe, feasible, and durable in patients with difficult anatomy who do not meet instructions for use as demonstrated in this limited series. (J Vasc Surg 2018;68:1688-95.)

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Endovascular Repair with Chimney Technique for Juxtarenal Aortic Aneurysm: A Single Center Experience

Abstract: Ch-EVAR can be used to treat JRAAs with suitable anatomical conditions. However, complications of type I endoleak were not uncommon, and, therefore, further studies are required to prove its efficiency for JRAAs.

Cited by 31 publications

References 19 publications

Chimney Grafts in Aortic Stent Grafting: Hazardous or Useful Technique? Systematic Review of Current Data

Chimney Grafts in Aortic Stent Grafting: Hazardous or Useful Technique? Systematic Review of Current Data

Cerebrovascular Complications After Upper Extremity Access for Complex Aortic Interventions: A Systematic Review and Meta-Analysis

Adjunctive visceral artery chimney in patients undergoing Zenith Fenestrated aortic repair

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