A Proof-of-Concept In Vitro Study to Determine if EndoAnchors Can Reduce Gutter Size in Chimney Graft Configurations

Niepoth, Wouter W.; Bruin, Jorg L. de; Yeung, Kak K.; Lely, Rutger J.; Devrome, Andrea; Wisselink, Willem; Blankensteijn, Jan D.

doi:10.1583/13-4228.1

Cited by 31 publications

(45 citation statements)

References 14 publications

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“…Using in vitro models, Niepoth and colleagues showed that the use of EndoAnchors decreased the incidence of type 1a endoleaks associated with chimney graft stenting . They constructed silicone models that underwent Ch‐EVAR.…”

Section: Discussionmentioning

confidence: 99%

Preliminary results of adjunctive use of endoanchors in the treatment of short neck and pararenal abdominal aortic aneurysms

Galiñanes

Hernández

Krajcer

2015

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 99%

Preliminary results of adjunctive use of endoanchors in the treatment of short neck and pararenal abdominal aortic aneurysms

Galiñanes

Hernández

Krajcer

2015

Cathet Cardio Intervent

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“…Furthermore, because the risk of type IA endoleaks associated with the chimneygraft technique is directly proportional to the number of chimney grafts placed, we used an aortic fixation system to minimize these "gutter leaks." 9 The endovascular exclusion of a pararenal aneurysm is a complex procedure involving multiple techniques that, if executed precisely, can result in successful maintenance of visceral-artery perfusion via parallel stents, with minimal risk of morbidity and death. The chimney-graft technique is a viable alternative for high-risk patients who have a pararenal AAA and few treatment options.…”

Section: Discussionmentioning

confidence: 99%

Innovative Chimney-Graft Technique for Endovascular Repair of a Pararenal Abdominal Aortic Aneurysm

Galiñanes¹,

Hernandez-Vila²,

Krajcer³

2015

Texas Heart Institute Journal

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P rogressive aneurysmal degeneration after abdominal aortic aneurysm (AAA) repair can be challenging to treat. Multiple comorbidities, previous operations, and the need for suprarenal cross-clamping place this patient population at high risk for reoperation. 1 During a 5-year period, Conrad and co-authors 2 reported a 24% incidence of late aortic aneurysm proximal to the site of repair in 540 patients who had undergone elective open AAA repair.In 2003, Greenberg and colleagues 3 described an endovascular approach in which parallel visceral-artery stent-grafts were inserted and molded to the main body of the endograft after aneurysmal exclusion. Many other groups have adopted this technique, and short-term and intermediate results appear promising. [4][5][6] We recently used this technique with our own novel modifications to exclude a pararenal AAA while maintaining visceral-artery perfusion. Case ReportIn 2009, a 71-year-old man had undergone open repair of an AAA with a bifurcated 16-mm × 8-cm Dacron prosthetic graft (Fig. 1A). Four years later, he presented with proximal progression of his aneurysmal disease. Abdominal computed tomographic angiography (CTA) showed a 5.3-cm pararenal aneurysm involving both renal arteries (Fig. 1B). Because the patient was at high risk for reoperation, he was referred to us for endovascular aneurysm repair (EVAR). Computed tomographic angiography with 3-dimensional reconstruction revealed no infrarenal neck, thus precluding the use of a fenestrated device. The distance from the superior mesenteric artery (SMA) to the lowest renal artery was 10 mm. The distance from the SMA to the celiac artery was 9 mm. This provided a total approximate distance from the celiac artery to the lowest renal artery of 19 mm, and the celiac artery's diameter was 24 mm, so a chimney graft to the SMA and both renal arteries was considered a viable option. The patient's common femoral arteries (CFAs) were of adequate size for total percutaneous access.The procedure was performed in a hybrid angiography suite with a surgical team on standby. The patient was placed in a supine position, both sides of the groin were anesthetized with 2% buffered lidocaine, and moderate sedation was administered. Meticulous percutaneous access was achieved via fluoroscopic guidance of a 21G micropuncture needle. Bilateral femoral angiography was performed with use of a 3F Techniques

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“…In particular, endoanchors have been in vitro evaluated in reducing the size of gutters in Ch-EVAR with promising results. 7,8 In the past, we successfully sealed a type Ia endoleak after chimney technique by using coil embolization and biological glue infusion. 9 However, multiple coil embolization sessions were required which resulted in an increased cost and endograft infection.…”

Section: Discussionmentioning

confidence: 99%

New Chimney after Chimney EVAR for the Treatment of Type Ia Endoleak

et al. 2015

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The chimney graft (CG) technique can be a useful alternative in treating aortic aneurysms with challenging anatomy, regarding the proximal sealing zone. 1 Greenberg et al first described the "chimney" or "snorkel" graft technique as a bail out procedure to preserve renal arteries during endovascular aneurysm repair (EVAR) when the proximal edge of stent graft fabric protruded into the renal artery ostium. 2 Several recent studies have shown promising results by electively using this technique for the treatment of pararenal and thoracoabdominal aneurysms. 1,3 However, long-term endograft durability and proximal fixation remain significant concerns. A proximal type I endoleak, represents the Achilles heel of the technique and may require secondary interventions. 4 We describe a case of a patient who developed a type Ia endoleak after chimney EVAR (Ch-EVAR) for a juxtarenal AAA and underwent new proximal chimneys and placement of an aortic cuff. Case ReportA 66-year-old male patient was referred to our institution because of a symptomatic juxtarenal AAA (6.3 cm in maximal diameter, proximal neck length 0.3 cm, and neck diameter 24 mm) (►Fig. 1a). The patient suffered from coronary artery disease (history of myocardial infarction and previous coronary artery bypass graft), moderate chronic obstructive pulmonary disease (FEV 1 61% pred. and FVC 66% pred.), and hypothythyroism; a TIA and a transperitoneal left nephrectomy were also recorded in his medical history.Because of the patient's comorbidities, an endovascular approach was chosen to exclude the juxtarenal AAA. The option of a branched or fenestrated endograft was declined given the emergent nature of the case. With the intention of proximal landing zone extending and preserving the blood flow in superior mesenteric artery (SMA) and right renal artery (RRA), a Ch-EVAR procedure was planned. In the operation theater, under general anesthesia, access through both common femoral arteries was gained, after surgical exposure. The SMA was subsequently accessed through a percutaneously inserted 6F sheath in the left brachial artery and the RRA through the right brachial artery. Polytetrafluoroethylene covered self-expanding nitinol stents (Fluency, C.R. Bard, Murray Hill, NJ) were deployed into the SMA (7 Â 60 mm) and RRA (7 Â 60 mm). We estimated the main Keywords ► abdominal aortic aneurysm ► aneurysm ► celiac artery embolism ► endovascular approach ► endovascular repair ► mesenteric artery AbstractThe chimney graft (CG) technique can be a useful alternative in treating aortic aneurysms with challenging anatomy, regarding the proximal sealing zone. We describe the case of a patient who developed a type Ia endoleak after chimney endovascular aneurysm repair for a juxtarenal AAA and underwent a proximal CG reconfiguration and implantation of an aortic cuff. The crossing configuration of the CGs should be avoided as it may compromise the circumferential apposition of the endograft and impede the thrombosis of the perigraft gutters. A proximal reconfiguration of the CGs...

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A Proof-of-Concept In Vitro Study to Determine if EndoAnchors Can Reduce Gutter Size in Chimney Graft Configurations

Abstract: It is feasible to reduce gutters in CG configurations with the use of endoanchors in an in vitro juxtarenal aneurysm model.

Cited by 31 publications

References 14 publications

Preliminary results of adjunctive use of endoanchors in the treatment of short neck and pararenal abdominal aortic aneurysms

Preliminary results of adjunctive use of endoanchors in the treatment of short neck and pararenal abdominal aortic aneurysms

Innovative Chimney-Graft Technique for Endovascular Repair of a Pararenal Abdominal Aortic Aneurysm

New Chimney after Chimney EVAR for the Treatment of Type Ia Endoleak

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