The chimney technique has a complementary role in the endovascular repair of juxtarenal aortic aneurysms: There is no need for a paradigm shift but for accurate patient selection

摘要

To the Editors: We read with great interest the article by Katsargyris et al regarding the current literature on open, fenestrated (F-EVAR), and chimney graft endovascular repair (Ch-EVAR) of juxtarenal aortic aneurysms (JAAs). The au-thors performed a systematic search of the PubMed database between January 2001 and July 2012, ultimately selecting 10 studies comprising 931 patients treated with F-EVAR and 5 studies comprising 94 patients undergoing Ch-EVAR. The authors highlighted better results for F-EVAR compared to Ch-EVAR for 30-day mortality (not statistically significant), ischemic stroke (p=0.012), and early proximal type I endoleak rate (p=4).002), leading to the conclusion that Ch-EVAR is only feasible. Recently, we published a pooled analysis of the literature concerning the early performance of Ch-EVAR and F-EVAR; however, there were significant differences in the results compared to the Katsargyris analysis.1 In this response, we want to clarify the role of both endovascular approaches based on our clinical practice and to discuss some issues arising from the Katsargyris article, which might have biased their results.