Multiple Periscope and Chimney Grafts to Treat Ruptured Thoracoabdominal and Pararenal Aortic Aneurysms

Pecoraro, Felice; Pfammatter, Thomas; Mayer, Dieter; Frauenfelder, Thomas; Papadimitriou, Dimitri; Hechelhammer, Lukas; Veith, Frank J.; Lachat, Mario; Rančić, Zoran

doi:10.1583/11-3556.1

Cited by 76 publications

(74 citation statements)

References 22 publications

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“…130 Endovascular parallel or "periscope" endograft techniques, can potentially be used to maintain perfusion through the coeliac artery. 131 Physician modified fenestrated endografts have also been used to maintain perfusion to the CA. The development of off the shelf fenestrated grafts may provide new options to treat acute DTA pathology involving visceral branches (see also Section 3.3.2.3.…”

Section: Iib B 104mentioning

confidence: 99%

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Riambau¹,

Böckler²,

Brunkwall³

et al. 2017

European Journal of Vascular and Endovascular Surgery

948

259

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Section: Iib B 104mentioning

confidence: 99%

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Riambau¹,

Böckler²,

Brunkwall³

et al. 2017

European Journal of Vascular and Endovascular Surgery

948

259

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“…The chimney technique has been applied and presented promising outcomes to extend the proximal landing zone during the endovascular repair of thoracic aortic aneurysms [8][9][10][11]. However, in aortic dissections, this technique might be substantially different from that in aneurysm repairs owing to anatomical and pathophysiologic differences.…”

Section: Introductionmentioning

confidence: 99%

Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

Huang

Tang

Qiao

et al. 2015

Cardiovasc Intervent Radiol

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Objective To summarize our early experience gained from the chimney technique for type B aortic dissection (TBAD) extending to the aortic arch and to evaluate the aortic remodeling in the follow-up period. Methods From September 2011 to July 2014, 27 consecutive TBAD patients without adequate proximal landing zones were retrograde analyzed. Chimney stent-grafts were deployed parallel to the main endografts to reserve flow to branch vessels while extending the landing zones. In the follow-up period, aortic remodeling was observed with computed tomography angiography. Results The technical success rate was 100 %, and endografts were deployed in zone 0 (n = 3, 11.1 %), zone 1 (n = 18, 66.7 %), and zone 2 (n = 6, 22.2 %). Immediately, proximal endoleaks were detected in 5 patients (18.5 %). During a mean follow-up period of 17.6 months, computed tomography angiography showed all the aortic stent-grafts and chimney grafts to be patent. Favorable remodeling was observed at the level of maximum descending aorta and left subclavian artery with expansion of true lumen (from 18.4 ± 4.8 to 25 ± 0.86 mm, p \ 0.001 and 27.1 ± 0.62 to 28.5 ± 0.37 mm, p \ 0.001) and depressurization of false lumen (from 23.7 ± 2.7 to 8.7 ± 3.8 mm, p \ 0.001, from 5.3 ± 1.2 to 2.1 ± 2.1 mm, p \ 0.001). While at the level of maximum abdominal aorta, suboptimal remodeling of the total aorta (from 24.1 ± 0.4 to 23.6 ± 1.5 mm, p = 0.06) and true lumen (from 13.8 ± 0.6 to 14.5 ± 0.4 mm, p = 0.08) was observed. Conclusion Based on our limited experience, the chimney technique with thoracic endovascular repair is demonstrated to be promising for TBAD extending to the arch with favorable aortic remodeling.

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“…Moreover, in this group of patients, CPG outcomes seemed far better than those of similar lesions treated by open aortic surgery. 40 During follow up, patient survival after non-elective procedures and procedures requiring more than two CPGs was worse than after elective procedures with one or two CPGs. Patients requiring elective treatment with only one or two CPGs clearly had the best outcomes.…”

Section: Discussionmentioning

confidence: 94%

Mid- and Longer-term Follow up of Chimney and/or Periscope Grafts and Risk Factors for Failure

Pecoraro¹,

Veith²,

Puippe³

et al. 2016

Journal of Vascular Surgery

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WHAT THIS PAPER ADDS Long-term follow up of chimney and periscope grafts for the treatment of pararenal and thoraco-abdominal aortic aneurysm is presented. This approach using off the shelf devices has been increasingly reported in recent years and with good results even in emergent settings. This risk factor analysis showed that inadequate branch graft length and chimney and periscope use in small and diseased target arteries contribute to late failure of this technique.Objective: The aim was to report on chimney and periscope grafts (CPGs) and their mid-and longer-term outcomes when they are used to preserve reno-visceral artery (RVA) perfusion in endovascular repair of pararenal (PRAAs) or thoraco-abdominal aortic aneurysm (TAAAs). In addition, factors associated with CPG failure are presented. Limited data exist on the outcomes of CPGs, and mid-and long-term results are generally not reported.Methods: This was a prospective study in a cohort of 100 patients with PRAA (69) or TAAA (31). A total of 224 (mean 2.24 per patient) RVAs were preserved with 136 (61%) chimney and 88 (39%) periscope grafts. CPGs were constructed mainly using self expandable stent grafts. Patients were followed by clinical examination, CTA (82%), and/or duplex (18%). Data were collected until February 2015. Results: CPG immediate technical success was 99% (222/224 branches). Mean follow up was 29 months (range 0e65; SD 17); 59% patients were followed > 2 years, 30% > 3 years, and 16% > 4 years. Post-operatively, CPG occlusion was observed early ( 30 days) in three (1.3%) branches and during follow up in 10 (4.5%). At 36 and 48 months, the estimated primary patency was 93% and 93%. After corrective percutaneous (10) or surgical (3) reinterventions, the estimated secondary patency was 96% and 96%. Thirty day mortality was 2%; at 36 and 48 months the estimated patient survival was 79%. Significant shrinkage (72 [SD 23] vs. 62 [SD 24] mm; p < .001) was observed, with a substantial reduction (>5 mm) in 55 patients, and sac enlargement in four. Incomplete aneurysm sac sealing was treated successfully by a secondary intervention in 15 patients. Conclusions: Self expandable CPGs have proved to be a highly successful and durable treatment for RVA preservation up to 5 years. Incomplete CPG expansion, inadequate length, and CPG use in small and diseased target arteries were risk factors for occlusion. These mid-and longer-term results support CPG use to treat PRAAs or TAAAs in patients unfit for open surgery or fenestrated/branched stent grafts. Ó

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Multiple Periscope and Chimney Grafts to Treat Ruptured Thoracoabdominal and Pararenal Aortic Aneurysms

Cited by 76 publications

References 22 publications

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

Mid- and Longer-term Follow up of Chimney and/or Periscope Grafts and Risk Factors for Failure

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