Use of covered chimney stents for pararenal aortic pathologies is safe and feasible with excellent patency and low incidence of endoleaks

Donas, Konstantinos P.; Pecoraro, Felice; Torsello, Giovanni; Lachat, Mario; Austermann, Martin; Mayer, Dieter; Panuccio, Giuseppe; Rančić, Zoran

doi:10.1016/j.jvs.2011.09.052

Cited by 120 publications

(136 citation statements)

References 12 publications

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“…With regard to the aortic stent graft there was no difference in outcome, maybe because of the relatively small samples. Few experimental and clinical data support the use of one device (aortic stent graft or branch stent graft) over another, 3,9,18,25 and long-term results with different types of CPG devices (self expandable or balloon expandable) are needed. 26 The Viabahn is preferred for CPG construction because of its low profile, flexibility, and heparin coating.…”

Section: Discussionmentioning

confidence: 99%

“…Endoleaks are regarded as a major concern 9 and represent a potential cause of aneurysm rupture. 26,30 The policy to perform very sensitive CTA (arterial and venous phases) early post-operatively might explain the 23% endoleak incidence.…”

Section: Discussionmentioning

confidence: 99%

“…High flow endoleaks I/III or relevant CPG stenoses were corrected immediately. Low flow endoleaks, 9 Type II endoleak and slight stenosis not associated with a significant pressure gradient were managed conservatively.…”

Section: Peri-operative Managementmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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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“…Renal function impairment was noted in 11.8 % of patients, with a 30-day in-hospital mortality of 4.3 %. Most recently, Donas and associates [82] reported the use of chimney stents for pararenal aortic pathology. In that study, 127 vessels in a total of 72 patients were revascularized using both balloon-expandable covered stents (Advanta, Atrium, Hudson, NH) and self-expandable stents (Viabahn, WL Gore, Flagstaff, AZ).…”

Section: Several Reports Frommentioning

confidence: 99%

Endovascular Repair of Complex Aortic Pathology

et al. 2013

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Aortic aneurysms are classified as complex based on their extent and involvement of side branches. Complex aortic aneurysms include arch, thoracoabdominal, juxtarenal and suprarenal aortic aneurysms. Open surgical repair carries high morbidity and mortality beyond large tertiary care centers. During the last decade, numerous technological advances have allowed incorporation of side branches using hybrid and total endovascular techniques. Fenestrated and branched endografts have been widely applied to treat patients with complex aneurysm anatomy. Newer stent graft designs are currently under clinical investigation offering an off-the-shelf alternative to custom-made stent grafts for patients with complex aortic aneurysms. Alternatively, a number of endovascular techniques have been described including chimney, snorkel, periscope and sandwich stent grafts. This article summarizes the current status of hybrid and total endovascular techniques to repair of thoracoabdominal, juxtarenal and suprarenal aortic aneurysms.

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“…One such technique is the chimney graft, in which a covered or bare metal stent is deployed parallel and outside of the aortic endograft, See commentary page 7 inflow upward (i.e., periscopes) or downward (i.e., chimneys), to retain or rescue blood flow into aortic branches along the sealing zones. 2,3 The published experience with this minimally invasive aortic branch preservation technique does not allow drawing robust conclusions, 2,3 primarily because mid-and long-term results of this novel technique are lacking. 2 The current article aims to present midterm (24-month) results of contrast-enhanced computed tomographic angiography (CTA) in a large cohort of patients with pararenal aortic pathologies treated by means of chimney and periscope endografts.…”

mentioning

confidence: 99%

CT Angiography at 24 Months Demonstrates Durability of EVAR With the Use of Chimney Grafts for Pararenal Aortic Pathologies

Donas

Pecoraro

Bisdas

et al. 2013

Journal of Endovascular Therapy

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PURPOSE: To present the 24-month radiological follow-up data for patients with pararenal aortic pathologies treated with chimney and periscope grafts during endovascular repair. METHODS: Between January 2008 and December 2011, 124 high-risk patients with complex pararenal aortic pathologies were treated using the chimney technique at 2 European vascular and cardiovascular centers with advanced experience of the described technique. In particular, 50 patients were treated at Site 1 and 74 at Site 2. Forty (32.2%) patients (32 men; mean age 79.2±4.9 years) completed computed tomographic angiography follow-up at 24 months postoperatively. RESULTS: The overall technical success was 100%, and the early-and midterm procedure-related mortality was 0%. Three (2.4%) patients had a perioperative type Ia endoleak that persisted; two were treated by transbrachial perigraft embolization and cuff implantation. The last patient is under radiological surveillance due to a "low-flow" type Ia endoleak and stable sac size. A type II endoleak was detected in 7 (5.6%) patients. During the 2-year follow-up, significant shrinkage (>5 mm; n=22) or stable aneurysm diameter (n=14) was seen in 36 (90%) of the cases. Overall, mean aneurysm sac shrinkage was 12% (p=0.002) and 10% (p=0.014) for the 2 centers, respectively (overall p=0.008). The causes for sac progression in the 4 (10%) patients were a type Ia endoleak, 2 type II endoleaks, and endotension. CONCLUSION: The present study demonstrates that the use of chimney and/or periscope endografts for pararenal aortic pathologies achieves and maintains successful exclusion of the aneurysm in 90% of the cases at 24 months of radiological follow-up. In centers experienced with this approach, the chimney technique may represent a reliable therapeutic modality in selected patients.

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Use of covered chimney stents for pararenal aortic pathologies is safe and feasible with excellent patency and low incidence of endoleaks

Abstract: In summary, midterm results of use of covered chimney stents for pararenal aortic pathologies show safety and feasibility with excellent patency and low incidence of endoleaks.

Cited by 120 publications

References 12 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

Endovascular Repair of Complex Aortic Pathology

CT Angiography at 24 Months Demonstrates Durability of EVAR With the Use of Chimney Grafts for Pararenal Aortic Pathologies

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