Abstract
Purpose
To report the first experience using the chimney technique in combination with the latest-generation low-profile stent-graft to seal abdominal aortic aneurysms having a very short neck (proximal sealing zone) and difficult access due to very small iliac vessels.
Materials and Methods
Use of an ultra low-profile 14F delivery aortic stent-graft system (Ovation; Trivascular, Santa Rosa, CA) with chimneys to the lowermost renal arteries in two patients who were not anatomically suitable for endovascular aortic aneurysm repair (EVAR) and too frail for open surgery.
Results
Implantation of stent-grafts and chimneys was technically successful without endoleak or other postinterventional complications. Follow-up after >1 year confirmed complete aneurysm exclusion, shrinkage of the aneurysm sac, and patent renal perfusion by way of the chimney.
Conclusion
Ultra low–profile aortic stent-graft systems are particularly helpful in case of inadequate small iliac access vessels and allow EVAR for short-necked aortic aneurysms if technical contraindications obviate FEVAR and physical impairment discourages open surgical repair.
References
Moulakakis KG, Dalainas I, Kakisis J, Giannakopoulos TG, Liapis CD (2012) Current knowledge on EVAR with the ultra-low profile Ovation Abdominal Stent-graft System. J Cardiovasc Surg (Torino) 53(4):427–432
Ovation Abdominal Stent Graft System Instructions For Use (2012) TriVascular Inc., Santa Rosa, CA
Moulakakis KG, Mylonas SN, Avgerinos E et al (2012) The chimney graft technique for preserving visceral vessels during endovascular treatment of aortic pathologies. J Vasc Surg 55(5):1497–1503
Cheng D, Martin J, Shennib H et al (2010) Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease a systematic review and meta-analysis of comparative studies. J Am Coll Cardiol 55(10):986–1001
Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D, Sculpher MJ (2010) Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 362(20):1863–1871
Schepens MAAM, Kelder JC, Morshuis WJ, Heijmen RH, van Dongen EP, ter Beek HTM (2007) Long-term follow-up after thoracoabdominal aortic aneurysm repair. Ann Thorac Surg 83(2):S851–S855 discussion S890–S892
Verhoeven ELG, Vourliotakis G, Bos WTGJ et al (2010) Fenestrated stent grafting for short-necked and juxtarenal abdominal aortic aneurysm: an 8-year single-centre experience. Eur J Vasc Endovasc Surg 39(5):529–536
Bakoyiannis CN, Economopoulos KP, Georgopoulos S et al (2010) Fenestrated and branched endografts for the treatment of thoracoabdominal aortic aneurysms: a systematic review. J Endovasc Ther 17(2):201–209
Donas KP, Pecoraro F, Torsello G et al (2012) Use of covered chimney stents for pararenal aortic pathologies is safe and feasible with excellent patency and low incidence of endoleaks. J Vasc Surg 55(3):659–665
Donas KP, Eisenack M, Panuccio G, Austermann M, Osada N, Torsello G (2012) The role of open and endovascular treatment with fenestrated and chimney endografts for patients with juxtarenal aortic aneurysms. J Vasc Surg 56(2):285–290
Kolvenbach RR, Yoshida R, Pinter L, Zhu Y, Lin F (2011) Urgent endovascular treatment of thoraco-abdominal aneurysms using a sandwich technique and chimney grafts—A technical description. Eur J Vasc Endovasc Surg 41(1):54–60
Ohrlander T, Sonesson B, Ivancev K, Resch T, Dias N, Malina M (2008) The chimney graft: a technique for preserving or rescuing aortic branch vessels in stent-graft sealing zones. J Endovasc Ther 15(4):427–432
Bruen KJ, Feezor RJ, Daniels MJ, Beck AW, Lee WA (2011) Endovascular chimney technique versus open repair of juxtarenal and suprarenal aneurysms. J Vasc Surg 53(4):895–904 discussion 904–905
Pecoraro F, Pfammatter T, Mayer D et al (2011) Multiple periscope and chimney grafts to treat ruptured thoracoabdominal and pararenal aortic aneurysms. J Endovasc Ther 18(5):642–649
Coscas R, Kobeiter H, Desgranges P, Becquemin J-P (2011) Technical aspects, current indications, and results of chimney grafts for juxtarenal aortic aneurysms. J Vasc Surg 53(6):1520–1527
Kölbel T, Carpenter SW, Taraz A, Taraz M, Larena-Avellaneda A, Debus ES (2013) How to calculate the main aortic graft-diameter for a chimney-graft. J Cardiovasc Surg (Torino). [Epub ahead of print]
Antoniou GA, Schiro A, Antoniou SA et al (2012) Chimney technique in the endovascular management of complex aortic disease. Vascular 20(5):251–261
Donas KP, Torsello G, Austermann M, Schwindt A, Troisi N, Pitoulias GA (2010) Use of abdominal chimney grafts is feasible and safe: short-term results. J Endovasc Ther 17(5):589–593
Cuypers PW, Laheij RJ, Buth J (2000) Which factors increase the risk of conversion to open surgery following endovascular abdominal aortic aneurysm repair? The EUROSTAR collaborators. Eur J Vasc Endovasc Surg 20(2):183–189
Velazquez OC, Larson RA, Baum RA et al (2001) Gender-related differences in infrarenal aortic aneurysm morphologic features: issues relevant to ancure and talent endografts. J Vasc Surg 33(2 Suppl):S77–S84
Hinchliffe RJ, Ivancev K, Sonesson B, Malina M (2007) “Paving and cracking”: an endovascular technique to facilitate the introduction of aortic stent-grafts through stenosed iliac arteries. J Endovasc Ther 14(5):630–633
Conflict of interest
Dr. med. Alexander Massmann and Prof. Dr. med. Arno Buecker have nothing to disclose. Ferdinand Serracino-Inglott reports personal fees from Trivascular, outside the submitted work.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Massmann, A., Serracino-Inglott, F. & Buecker, A. Endovascular Aortic Repair With the Chimney Technique Using the Ultra Low–Profile Ovation Stent-Graft for Juxtarenal Aneurysms Having Small Iliac Access Vessels . Cardiovasc Intervent Radiol 37, 488–492 (2014). https://doi.org/10.1007/s00270-013-0748-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-013-0748-2