Midterm outcomes and evolution of gutter area after endovascular aneurysm repair with the chimney graft procedure

Beaufort, Hector W.L. de; Cellitti, Elena; Ruiter, Quirina M.B. de; Conti, Michele; Trimarchi, Santi; Moll, Frans L.; Hazenberg, Constantijn E.V.B.; Herwaarden, Joost A. van

doi:10.1016/j.jvs.2017.04.067

Cited by 19 publications

(10 citation statements)

References 26 publications

(36 reference statements)

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“…In terms of technique, the approach utilized suffers from the limitation that chimney graft would possibly enlarge the risk of endoleak. [16,17] Therefore, the present findings confirmed that the PAU was located at the anterior wall of aorta arch, so that the graft we chose was oversized, nearly 10% to 15% larger than the precise diameter of aorta and the chimney stent was implanted at the posterior wall of graft in order to decrease the risk of endoleak.…”

Section: Discussionsupporting

confidence: 73%

Thoracic endovascular aortic repair in penetrating aortic ulcer combined with isolated left vertebral artery

Fan

Li²,

Zheng³

et al. 2019

Medicine

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Rationale:Penetrating aorta ulcer (PAU) with isolated left vertebral artery (ILVA) is a rare condition, accounting for no more than 1% of all kinds of aorta diseases. And traditional treatment was open surgery with total arch replacement by elephant trunk. Here, we report a case of PAU combined with ILVA managed by thoracic endovascular aortic repair (TEVAR) technique.Patient concerns:A 65-year-old male with chronic hypertension and Nicotine abuse underwent intermittent back pain for 2 years and aggravated a bit for 1 week.Diagnoses:Preoperative computed tomography angiogram (CTA) indicated PAU combined with ILVA.Interventions:TEVAR was performed for PAU following with retrograde in situ fenestration and chimney technique for revascularization of ILVA and left subclavian artery (LSA), respectively.Outcomes:The operation was successfully and the patient was discharged from hospital after 1 week of treatment. Postoperatively, the images of CTA illustrated the patency of aorta, ILVA, and LSA without obvious endoleak. Besides, no ischemia attack or other relative syndromes were detected at 6-months follow-up.Lessons:This case demonstrates that TEVAR is an alternative to elephant trunk especially for PAU with ILVA. And it also showed the precise exposure of ILVA and necessity to reconstruct ILVA during TEVAR operation in order to reduce the occurrence of ischemia attack.

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Section: Discussionsupporting

confidence: 73%

Thoracic endovascular aortic repair in penetrating aortic ulcer combined with isolated left vertebral artery

Fan

Li²,

Zheng³

et al. 2019

Medicine

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“…8 Small paragraft gutters do not influence successful endovascular repair, since they are occluded by progressive thrombus formation during early follow-up. 5,25 In addition, de Beaufort et al 31 describe a reduction of gutter sizes in CG configurations during follow-up. Hence, most perioperative type Ia endoleaks do not persist during midterm follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, most perioperative type Ia endoleaks do not persist during midterm follow-up. 5,8,25,31 However, Niepoth et al 17 state that these paragraft gutters might increase or decrease based on vascular wall movements and through the force of blood pressure on the proximal sealing zone, which could lead to aneurysm growth and the need for secondary interventions. It should be noted, though, that the geometrical changes in paragraft gutters observed in our static models in a gelatin-water environment were not tested for the influence of pressure or spontaneous thrombosis of these gutters.…”

Section: Discussionmentioning

confidence: 99%

Secondary Fill Minimizes Gutter Size in Chimney EVAS Configurations In Vitro

et al. 2018

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To investigate in an in vitro model if secondary endobag filling can reduce gutter size during chimney endovascular aneurysm sealing (chEVAS). Materials and Methods: Nellix EVAS systems were deployed in 2 silicone juxtarenal aneurysm models with suprarenal aortic diameters of 19 and 24 mm. Four configurations were tested: EVAS with 6-mm balloon-expandable (BE) or self-expanding (SE) chimney grafts (CGs) in the renal branches of both models. Balloons were inflated simultaneously in the CGs and main endografts during primary and secondary endobag filling and polymer curing. Computed tomography (CT) was performed immediately after the primary and secondary fills. Cross-sectional lumen areas were measured on the CT images to calculate gutter volumes and percent change. CG compression was calculated as the reduction in lumen surface area measured perpendicular to the central lumen line. The largest gutter volume and highest compression were presented per CG configuration per model. Results: Secondary endobag filling reduced the largest gutter volumes from 99.4 to 73.1 mm 3 (13.2% change) and 84.2 to 72.0 mm 3 (27.6% change) in the BECG configurations and from 67.2 to 44.0 mm 3 (34.5% change) and 92.7 to 82.3 mm 3 (11.2% change) in the SECG configurations in the 19-and 24-mm models, respectively. Secondary endobag filling increased CG compression in 6 of 8 configurations. BECG compression changed by −0.2% and 5.4% and by −1.0% and 0.4% in the 19-and 24-mm models, respectively. SECG compression changed by 10.2% and 16.0% and by 7.2% and 7.3% in the 19-and 24-mm models, respectively. Conclusion: Secondary endobag filling reduced paragraft gutters; however, this technique did not obliterate them. Increased CG compression and prolonged renal ischemia time should be considered if secondary endobag filling is used.

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“…The main source of these leaks is the gutter that arises from inadequate sealing between the parallel grafts. [18][19][20] Such gutters are difficult to seal completely with the current techniques 20 ; however, longer overlapping of chimney grafts with the main graft may reduce the gutter size. 3 The fenestration technique, on the other hand, can result in complete sealing of the main graft and branches to the aortic wall and arteries, respectively.…”

Section: Discussionmentioning

confidence: 99%

Off-the-Shelf Devices for Treatment of Thoracic Aortic Diseases: Midterm Follow-up of TEVAR With Chimneys or Physician-Made Fenestrations

Zhang

Zhu

et al. 2019

J Endovasc Ther

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Purpose: To evaluate the midterm outcomes of thoracic endovascular aortic repair (TEVAR) using chimney grafts (ch-TEVAR) or thoracic stent-grafts with fenestrations made on the back table (f-TEVAR) to treat thoracic aortic dissection (TAD) and thoracic aortic aneurysm (TAA). Materials and Methods: A retrospective analysis was conducted of 474 consecutive patients (mean age 62.3±10.7 years; 346 men) treated with either f-TEVAR (n=110) or ch-TEVAR (n=364) for 352 TADs (81 f-TEVAR and 271 ch-TEVAR) or 122 TAAs (29 f-TEVAR and 93 ch-TEVAR) from 2008 to 2016. The primary endpoints at 30 days and during follow-up were overall mortality, aorta-related mortality, and major complications. The secondary endpoints were endoleak and reintervention. The patency of the target branches, cost of hospitalization, and the use of antiplatelet drugs were also analyzed. Results: Intraoperative type I endoleaks were treated in 69 (14.6%) cases (4 f-TEVAR and 65 ch-TEVAR, p<0.01) to achieve 100% technical success. Four (0.8%) patients died within 30 days [1 (0.9%) f-TEVAR and 3 (0.8%) ch-TEVAR]. Perioperative cerebral ischemia (1 fatal stroke) occurred in 9 (1.9%) patients: (1 f-TEVAR and 8 ch-TEVAR, p=0.39). During the mean follow-up of 50.6±20.0 months (49.5±18.3 months in f-TEVAR and 50.9±20.6 months in ch-TEVAR), 11 (2.3%) patients died of an aorta-related event. Type I endoleak was present in 40 (8.4%) patients (1 f-TEVAR and 39 ch-TEVAR, p<0.01). Eleven (2.3%) patients experienced stent-graft migration and 13 (2.7%) had a retrograde dissection. One hundred (16.9%) of the 593 branch stents occluded (4/75 in the f-TEVAR group and 96/518 in the ch-TEVAR group, p<0.01). The branch reintervention rate was 7.2% (34/474). The f-TEVAR group had a significantly higher probability of freedom from branch occlusion (92%) than the ch-TEVAR group (83%, p=0.007). Conclusion: Off-the-shelf techniques employing chimney grafts and homemade fenestrations are both suitable options for TAD and TAA involving the supra-aortic branches, with a low incidence of reintervention. Fenestrated TEVAR seems to have more favorable short- and midterm outcomes. Further study of these off-the-shelf techniques for aortic arch repair is warranted.

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Midterm outcomes and evolution of gutter area after endovascular aneurysm repair with the chimney graft procedure

Cited by 19 publications

References 26 publications

Thoracic endovascular aortic repair in penetrating aortic ulcer combined with isolated left vertebral artery

Thoracic endovascular aortic repair in penetrating aortic ulcer combined with isolated left vertebral artery

Secondary Fill Minimizes Gutter Size in Chimney EVAS Configurations In Vitro

Off-the-Shelf Devices for Treatment of Thoracic Aortic Diseases: Midterm Follow-up of TEVAR With Chimneys or Physician-Made Fenestrations

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