Is Chimney EVAR an Acceptable Endovascular Technique ?

摘要

Ballesteros-Pomar et al.1report a case of pararenal aneurysmtreated by a chimney EVAR technique, complicated by apersistent type Ia endoleak, treated three months later byembolisation of the endoleak with coils and onyx. Althoughuse of the Chimney EVAR technique in the management ofaortic aneurysms is currently in fashion, this type of intervention constitutes an experimental model for proximal periprosthetic endoleak whose incidence is largely undervalued.Among the therapeutic options to be discussed, it islogical to rule out the hypothesis of a fenestrated endoprosthesis if the patient is symptomatic, but several optionscould be proposed including hybrid surgery with visceralartery debranching and aortic endoprosthesis, homemadefenestrated endoprosthesis, or open surgery with retroperitoneal access. It is therefore a pararenal aneurysm thatcould be effectively treated by open surgery with shortduration suprarenal clamping. The results of conventionalAAA surgery have been detailed by several authors(Steinmetz,2Aune, Ballotta, Paolini), from population databases (Jetty, Patel3), national registers (Mani), major prospective trials (Zwolak4), or large meta-analyses (Bahia,Hennebiens5). With mortality rates at one and three monthsof 2.2% and 3.9%, respectively, in a population of high risksurgical patients, conventional AAA surgery is an effectiveand reliable strategy that can be proposed as a second linesolution in the situation of anatomical contraindications toperforming simple endovascular treatment.