Endovascular repair of complex aneurysms. Importance of alternative techniques

摘要

abstract_textpParallel grafts are an emerging alternative to open surgery for complex aneurysm repair. In most cases custom-made devices can be used in many instances but are associated with considerable manufacturing time and costs. Chimney techniques can provide an off-the-shelf solution. A distinction is made between plain chimney grafts to maintain perfusion of side branches, such as the renal arteries and more complex repair techniques to treat thoracoabdominal aortic aneurysms with sandwich grafts. Indications and different deployment techniques of various configurations, such as periscope grafts are described. Chimney grafts can either be used as a salvage technique after accidental covering of a renal artery or as a side branch running in parallel to an aortic graft. Mid-term results and multicenter studies are discussed in this article. Sandwich grafts offer a readily available solution for thoracoabdominal aortic aneurysms. Here the branches and the gutters are between two aortic stent grafts rather than between the native aorta and the aortic stent which further stabilizes the branches and reduces friction. Persicope grafts can replace upward facing chimney grafts in those cases where a narrow aorta does not permit placement of four branches or where a two team approach is favored to save time. These techniques can be used not only for suprarenal and thoracoabdominal but also for aortic arch aneurysms. There are only few studies so far with mid-term results equal to the mid-term and long-term results of custom-made branched and fenestrated devices. This review outlines alternative techniques for complex aneurysm repair. Although they are technically feasible with low morbidity and mortality, robust data supporting their use are lacking. Long-term durability and target vessel patency have still to be determined. Challenges particularly in aortic arch and thoracoabdominal aortic aneurysms currently make parallel grafts an attractive alternative to other endovascular techniques or open surgical procedures. However, as there is a lack of long-term data it is not known whether these off-the-shelf techniques are only an intermediate step until premanufactured off-the-shelf devices become more widely available./p/abstract_text