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4. Current role of the chimney technique in the treatment of complex abdominal aortic pathologies: A position paper from the PERICLES Registry investigators

Author

Donas, K. P., Criado, F., Torsello, G., Riambau, V., Scali, S., Minion, D., T. Lee J., Lachat, M., Y Woo, E., Veith, F. J., Fazzini, S., Taneva, Gt., Dalman, Rl, Tran, K, Pecoraro, F, Bisdas, T, Seifert, S, Esche, M, Gasparini, Frigatti, P, Adovasio, R, Mucelli, Fp, Damrauer, Sm, Salenius, J, Suominen, V, Mangialardi, N, Ronchey, S, Mestres, G, Mosquera, Nj., Donas K.P., Criado F., Torsello G., Riambau V., Scali S., Minion D., Lee J.T., Lachat M., Woo E.Y., Veith F.J., Fazzini S., Taneva G.T., Dalman R.L., Tran K., Pecoraro F., Bisdas T., Seifert S., Esche M., Gasparini D., Frigatti P., Adovasio R., Mucelli F.P., Damrauer S.M., Salenius J., Suominen V., Mangialardi N., Ronchey S., Mestres G., and Mosquera N.J.

Subjects
medicine.medical_specialty, Endoleak, Chimney technique, pararenal aneurysms, endovascular aortic repair, Risk Assessment, pararenal aneurysms, Blood Vessel Prosthesis Implantation, Risk Factors, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Chimney, Registries, Chimney technique, endovascular aortic repair, Evidence-Based Medicine, business.industry, Endovascular Procedures, General Medicine, Blood Vessel Prosthesis, Treatment Outcome, Position paper, Stents, Surgery, Radiology, Current (fluid), Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal
Abstract

Historically, chimney/snorkel endovascular aortic repair (Ch-EVAR) emerged as a rescue technique to revascularize and/or preserve inadvertently covered critical branch vessels during infrarenal aortic endografting. Next, in its evolutionary path, Ch-EVAR offered a viable treatment option for complex aortic repair, and particularly in situations where fenestrated/ branched EVAR was not a therapeutic option due to the lack of availability and/or anatomical constraints. In this context, this technique offered distinct advantages such as off-the-shelf availability, straightforward implantation techniques, and lower resource use-intensity enabling performance by a large number of operators managing patients in many centers around the world.

Published
2020

5. Results of chimney endovascular aneurysm repair as used in the PERICLES Registry to treat patients with suprarenal aortic pathologies

Author

Salvatore T. Scali, Fabio Pozzi Mucelli, Scott M. Damrauer, Felice Pecoraro, Sven Seifert, Mirko Esche, Theodosios Bisdas, Edward Y. Woo, Juha Salenius, Nilo J. Mosquera, Paul Kubilis, Paolo Frigatti, Ronald L. Dalman, Gergana T Taneva, Stefano Fazzini, Sonia Ronchey, David J. Minion, Gaspar Mestres, Giovanni Torsello, Konstantinos P. Donas, Daniele Gasparini, Frank J. Veith, Velipekka Suominen, Nicola Mangialardi, Frank J. Criado, Kenneth Tran, Roberto Adovasio, Vincent Riambau, Jason T. Lee, Taneva G.T., Criado F.J., Torsello G., Veith F., Scali S.T., Kubilis P., Donas K.P., Dalman R.L., Tran K., Lee J., Pecoraro F., Bisdas T., Seifert S., Esche M., Gasparini D., Frigatti P., Adovasio R., Mucelli F.P., Damrauer S.M., Woo E.Y., Minion D., Salenius J., Suominen V., Mangialardi N., Ronchey S., Fazzini S., Mestres G., Riambau V., and Mosquera N.J.

Subjects
Male, Time Factors, medicine.medical_treatment, Technical success, 030204 cardiovascular system & hematology, Endovascular aneurysm repair, Settore MED/22 - Chirurgia Vascolare, Postoperative Complications, Renal Artery, 0302 clinical medicine, Risk Factors, Superior mesenteric artery, Chimney, Registries, 030212 general & internal medicine, Aged, 80 and over, Triple chimney EVAR, Incidence (epidemiology), Endovascular Procedures, Chimney graft, Europe, Suprarenal aneurysms, Treatment Outcome, Cohort, Female, Stents, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Aortic Diseases, Prosthesis Design, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, Aneurysm, Mesenteric Artery, Superior, medicine.artery, medicine, Humans, Complex aneurysm, Aged, Retrospective Studies, Suprarenal aneurysm, business.industry, Complex aneurysms, Multiple chimney EVAR, medicine.disease, United States, Blood Vessel Prosthesis, Surgery, business
Abstract

Background: The prevailing evidence calls for using chimney/snorkel endovascular repair (ch-EVAR) with one or two chimney grafts. No studies up to now focus on its applicability and results for the treatment of suprarenal aortic pathologies (SRAP). Hence, we evaluated the clinical and radiologic results of ch-EVAR treatment for SRAP placing three or more chimney grafts within the PERICLES Registry. Methods: Data from 517 patients suffering complex aortic pathologies treated by ch-EVAR between 2008 and 2014 at 13 European and U.S. centers were retrospectively reviewed and analyzed. Results: Sixty-seven ch-EVAR-treated patients (12.9% of the entire PERICLES cohort) presented SRAP (83.5% elective, 16.5% urgent). The majority of patients (95.5%) received three chimney grafts; four patients received four chimney grafts. The Endurant device was the most commonly used (35.8%) followed by the Zenith abdominal endograft (19.4%). Overall, 204 chimney grafts were placed (56.7% covered self-expandable, 40.3% covered balloon-expandable stents, and 10.4% bare metal balloon-expandable stents). At a median follow-up of 24 months (range, 0.1-67.0 days), 30-day mortality was 6.1% (4 patients), and the overall mortality was 16.4% (11 patients). Overall survival was 87.4% (range, 79.5%-96.0%) at 1 year, 81.8% (range, 72.2%-92.2%) at 2 years and thereafter. Type IA endoleak was noted in nine patients (13.4%) intraoperatively and successfully treated in seven cases (97.1% technical success). Aneurysm sac diameter significantly decreased from 70.5 ± 19.3 mm to 66.9 ± 20.6 mm (P

Published
2020

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