Systematic review of chimney and periscope grafts for endovascular aneurysm repair

Wilson, Alasdair; Zhou, S; Bachoo, Paul; Tambyraja, Andrew L.

doi:10.1002/bjs.9274

Cited by 76 publications

(65 citation statements)

References 28 publications

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“…20 As reported recently by the multicenter PERICLES registry, the results at 17.1 months from 517 patients treated by CPGs were similar to those of F/BEVAR. However, in this registry different devices (bare metal, covered, self expandable, or balloon expandable) have been used in reno-visceral vessels and no risk factor analysis for CPG failure was performed.…”

Section: Discussionsupporting

confidence: 80%

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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Section: Discussionsupporting

confidence: 80%

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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“…The beneficial effect of this new technique has been documented in reviews (Katsagyris et al 2013, Wilson et al 2013) but long-term data, especially regarding emergent cases has been limited. Mortality from the procedure even if it requires more access sites and longer procedural time for repair has been favorable ).…”

Section: Modern Results Of Chimney Stent Graftsmentioning

confidence: 99%

“…The published cases of thoracic pathologies combined with CG-grafts are definitively more complex (Wilson et al 2013). Nevertheless, the results are promising but maybe the hemodynamic forces are even more overwhelming in the arch of aorta even if not proven (Katsagyris et al 2013, Wilson et al 2013).…”

Section: Modern Results Of Chimney Stent Graftsmentioning

confidence: 99%

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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“…Ruptured juxtarenal AAA are morphologically unsuitable for immediate endovascular treatment, but not impossible. Chimney technique can be used with higher risk for proximal perigraft type Ia endoleak 52,53 . With increasing surgical specialisation and centralisation, some surgical emergencies are treated only in specialised centres.…”

Section: Treatment Of Ruptured Aneurysmsmentioning

confidence: 99%

Acute aorta, overview of acute CT findings and endovascular treatment options

Černá¹,

Köcher²,

Thomas³

2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Acute aortic pathologies include acute aortic syndrome (aortic dissection, intramural hematoma, penetrating aortic ulcer), impending rupture, aortic aneurysm rupture and aortic trauma. Acute aortic syndrome, aortic aneurysm rupture and aortic trauma are life-threatening conditions requiring prompt diagnosis and treatment. The basic imaging modality for "acute aorta" is CT angiography with typical findings for these aortic pathologies. Based on the CT, it is possible to classify aortic diseases and anatomical classifications are essential for the planning of treatment. Currently, endovascular treatment is the method of choice for acute diseases of the descending thoracic aorta and is increasingly indicated for patients with ruptured abdominal aortic aneurysms.

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Systematic review of chimney and periscope grafts for endovascular aneurysm repair

Abstract: These highly selected data support the potential value of chimney and periscope graft techniques for patients with challenging aortic aneurysm morphology. There is a lack of medium- and long-term follow-up data.

Cited by 76 publications

References 28 publications

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

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

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

Acute aorta, overview of acute CT findings and endovascular treatment options

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