Objectives This study evaluated the safety and efficacy of endovascular aortic repair (EVAR) plus adjunctive chimney technique in the treatment of pararenal abdominal aortic aneurysm using a single model of abdominal device in a real-world experience.Methods Data on all consecutive patients treated in 14 different Italian centers over a 7-year period (2007-2014) were collected. To ensure homogeneity, only procedures performed with one single model of graft, the Gore Excluder AAA Endoprosthesis (W. L. Gore, Flagstaff, Ariz) bifurcated endograft were included. Preoperative and postoperative CT scans of all patients were evaluated by a dedicated core laboratory blinded to clinical data. Go Results During the study period, 52 patients underwent EVAR with chimney technique. In 40.3% of cases, surgery was conducted in an urgent setting (19 symptomatic patients and 2 ruptured aortic aneurysms). Mean aneurysm diameter at the time of intervention was 60.4 ± 12.8 mm. Procedures were performed under local anesthesia in 23 cases (44.2%). Total number of chimney stents was 75 (1.4/patient), and mean contrast media use was 178 ± 90 mL. Technical success was achieved in 88.5%, the remaining cases accounting for 2 intraoperative renal artery occlusions and 4 type I proximal endoleaks; 3 of these disappeared at 30-day CT control. Six reinterventions were performed within 30 days, 2 surgical corrections of groin hematoma, 2 type II endoleak embolizations, 1 type I endoleak correction (coiling and glue embolization), and 1 bilateral renal artery fibrinolysis. Furthermore, 1 patient underwent bowel resection for infarction. Two patients died perioperatively, 1 of myocardial infarction and 1 of multiorgan failure, both deaths on postoperative day 11. At a mean follow-up of 18.2 months 3 late reintervention were needed, 1 for a late renal occlusion and the other 2 for correction of type II endoleak. No late conversions or late aneurysm-related deaths were recorded. Go Conclusions The chimney technique may represent a safe and effective technique in the treatment of pararenal aneurysms when used in a suitable anatomy, even in urgent settings. Low risk of visceral occlusion may be achieved with a fully covered abdominal endograft and single or double chimney stents.
Results From the Pararenal Aneurysm Chimney Endovascular Repair (PACE), an Italian Multicenter Study
CIERI, ENRICO;SIMONTE, GIOELE;ISERNIA, GIACOMO;DE RANGO, PAOLA;VERZINI, Fabio
2016
Abstract
Objectives This study evaluated the safety and efficacy of endovascular aortic repair (EVAR) plus adjunctive chimney technique in the treatment of pararenal abdominal aortic aneurysm using a single model of abdominal device in a real-world experience.Methods Data on all consecutive patients treated in 14 different Italian centers over a 7-year period (2007-2014) were collected. To ensure homogeneity, only procedures performed with one single model of graft, the Gore Excluder AAA Endoprosthesis (W. L. Gore, Flagstaff, Ariz) bifurcated endograft were included. Preoperative and postoperative CT scans of all patients were evaluated by a dedicated core laboratory blinded to clinical data. Go Results During the study period, 52 patients underwent EVAR with chimney technique. In 40.3% of cases, surgery was conducted in an urgent setting (19 symptomatic patients and 2 ruptured aortic aneurysms). Mean aneurysm diameter at the time of intervention was 60.4 ± 12.8 mm. Procedures were performed under local anesthesia in 23 cases (44.2%). Total number of chimney stents was 75 (1.4/patient), and mean contrast media use was 178 ± 90 mL. Technical success was achieved in 88.5%, the remaining cases accounting for 2 intraoperative renal artery occlusions and 4 type I proximal endoleaks; 3 of these disappeared at 30-day CT control. Six reinterventions were performed within 30 days, 2 surgical corrections of groin hematoma, 2 type II endoleak embolizations, 1 type I endoleak correction (coiling and glue embolization), and 1 bilateral renal artery fibrinolysis. Furthermore, 1 patient underwent bowel resection for infarction. Two patients died perioperatively, 1 of myocardial infarction and 1 of multiorgan failure, both deaths on postoperative day 11. At a mean follow-up of 18.2 months 3 late reintervention were needed, 1 for a late renal occlusion and the other 2 for correction of type II endoleak. No late conversions or late aneurysm-related deaths were recorded. Go Conclusions The chimney technique may represent a safe and effective technique in the treatment of pararenal aneurysms when used in a suitable anatomy, even in urgent settings. Low risk of visceral occlusion may be achieved with a fully covered abdominal endograft and single or double chimney stents.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
