Chimney grafts for complex abdominal aortic aneurysms. Current status

摘要

abstract_textpPurpose. The aim of this article is to review the literature reporting the use of the chimney graft (CG) technique for the treatment of complex abdominal aortic aneurysms (AAA)./ppMethods. Studies were included in the present review if revascularization of visceral branches during endovascular treatment of complex AAAs was accomplished with the CG technique. Case reports and non-consecutive series with less than ten patients were excluded./ppResults. A total of 5 publications with a total number of 94 patients fulfilled the inclusion criteria. The CG procedure was applied for the treatment of primary pararenal or juxtarenal AAAs in 78.7 and for the repair of para-anastomotic pseudoaneurysms or endoleaks after prior open or endovascular repair in 19.2. Of the patients 2 (2.1 ) were operated on for atheromatous aortic occlusive disease and 16 (17) in an urgent setting. A total of 148 (average 1.57 per patient) visceral vessels were treated with CGs: 124 (83.8 ) renal arteries, 21 (14.2 ) superior mesenteric arteries (AMS) and 3 (2 ) celiac arteries (CT). Primary technical success was 96.8 with an early type I endoleak rate of 11 . The 30-day in-hospital mortality was 5.3 (5.1 and 6.3 for elective and urgent cases, respectively) and CG patency during follow-up (mean 9.9 months) was 97.3 . Postoperative renal function impairment occurred in 16 , cardiac complications in 7.4 and ischemic stroke in 3.2 of patients./ppConclusions. Early results of the CG method demonstrate feasibility but due to the lack of long-term outcome data this technique should be currently limited to bail-out procedures or acute situations. For elective cases, fenestrated stent grafting or open repair remain the treatments of choice./p/abstract_text