Fenestrated and Chimney Technique for Juxtarenal Aortic Aneurysm: A Systematic Review and Pooled Data Analysis

Abstract

Juxtarenal aortic aneurysms (JAA) account for approximately 15% of abdominal aortic aneurysms. Fenestrated endovascular aneurysm repair (FEVAR) and chimney endovascular aneurysm repair (CH-EVAR) are both effective methods to treat JAAs, but the comparative effectiveness of these treatment modalities is unclear. We searched the PubMed, Medline, Embase, and Cochrane databases to identify English language articles published between January 2005 and September 2013 on management of JAA with fenestrated and chimney techniques to conduct a systematic review to compare outcomes of patients with juxtarenal aortic aneurysm (JAA) treated with the two techniques. We compared nine F-EVAR cohort studies including 542 JAA patients and 8 CH-EVAR cohorts with 158 JAA patients regarding techniques success rates, 30-day mortality, late mortality, endoleak events and secondary intervention rates. The results of this systematic review indicate that both fenestrated and chimney techniques are attractive options for JAAs treatment with encouraging early and mid-term outcomes.

Endosuture aneurysm repair in patients treated with Endurant II/IIs in conjunction with Heli-FX EndoAnchor implants for short-neck abdominal aortic aneurysm

“…24,25 Rates of secondary endovascular interventions after chEVAR have a wider range but on average are similar. 5,26,27 There were no conversions to open repair after ESAR.…”

“…Total fluoroscopy time to complete ESAR averaged 35.3 minutes, with a mean duration of implant procedure of 148 minutes. A meta-analysis of fEVAR and chEVAR by Li et al 26 found that procedure length averaged 261 minutes for fEVAR and 178 minutes for chEVAR. Implantation of EndoAnchor implants on average required an additional 17 minutes to complete, an insignificant increase in total operative time.…”

Three-year follow-up of composite stent grafts used in the repair of Crawford Type III thoracoabdominal aortic aneurysms; A case report

“…Although endovascular options provide a less invasive approach and more favourable outcomes than open surgery in the management of TAAAs, more than 30% of patients are not suitable for conventional endovascular repair because of anatomic constraints around the proximal neck. 7 However, a number of endovascular techniques and devices have been developed to bypass these challenges. These include, branched, fenestrated and chimney stent graft techniques.…”

‘In-stock’ fenestrated stent graft for the urgent repair of an abdominal aortic aneurysm

“…The chimney technique involves the use of off-the-shelf covered stents placed between the main body graft and the aortic wall to facilitate perfusion of the renal arteries. Chimney stenting has been shown to have higher mortality and have a higher incidence of renal impairment when compared with fenestrated EVAR; however, it is typically performed in more urgent cases 4. Physician-modified stent grafts involve the partial deployment of the stent graft, creation of the appropriate fenestrations and resheathing of the stent graft prior to the deployment within the patient.…”