Chimney and Periscope Grafts Observed Over 2 Years After Their Use to Revascularize 169 Renovisceral Branches in 77 Patients With Complex Aortic Aneurysms

Abstract

PURPOSE: To evaluate the performance of periscope and/or chimney grafts (CPGs) in the endovascular treatment of pararenal or thoracoabdominal aneurysms using off-the-shelf devices. METH-ODS: Between February 2002 and August 2012, 77 consecutive patients (62 men; mean age 73±9 years) suffering from pararenal aortic (n=55), thoracoabdominal (n=16), or arch to visceral artery aneurysms (n=6) were treated with aortic stent-graft implantation requiring chimney and/or periscope grafts to maintain side branch perfusion. CPGs were planned in advance and were not used as bailout. A standardized follow-up protocol including computed tomographic angiography, laboratory testing, and clinical examination was performed at 6 weeks; 3, 6, and 12 months; and annually thereafter. RESULTS: Technical success was achieved in 76 (99%) patients; 1 branch stent-graft became dislocated from a renal artery, which could not be re-accessed. Overall, 169 target vessels (121 renal arteries, 30 superior mesenteric arteries, 17 celiac trunks, and 1 inferior mesenteric artery) were addressed with the chimney graft configuration in 111 and the periscope graft configuration in 58. In total, 228 devices were used for the CPGs: 213 Viabahn stent-grafts and 15 bare metal stents. Over a mean 25±16 months (range 1-121), 9 patients died of unrelated causes. Nearly all (95%) of the patients demonstrated a decreased or stable aneurysm size on imaging; there was a mean 13% shrinkage in aneurysm diameter. Twenty patients had primary type I/III endoleaks at discharge; in follow-up, only 3 of these were still present (no secondary or recurrent endoleaks were noted). Additional endovascular maneuvers were required for CPG-related complications in 13 patients from intervention throughout follow-up. Overall, 4 CPGs occluded (98% target vessel patency); no stent-graft migration was observed. Renal function remained stable in all patients. CONCLUSION: In this series, the use of CPGs has proven to be a feasible, safe, and effective way to treat thoracoabdominal and pararenal aneurysms with maintenance of blood flow to the renovisceral arteries. Nearly all of the aneurysms showed no increase in diameter over a >2-year mean follow-up, which supports the midterm adequacy of the CPG technique as a method to effectively revascularize branch vessels with few endoleaks or branch occlusions.

Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

“…The chimney technique has been applied and presented promising outcomes to extend the proximal landing zone during the endovascular repair of thoracic aortic aneurysms [8][9][10][11]. However, in aortic dissections, this technique might be substantially different from that in aneurysm repairs owing to anatomical and pathophysiologic differences.…”

Application of Zenith t-Branch system in symptomatic thoracoabdominal aortic aneurysm with unfavourable anatomy — case report

“…In presented case we did not decide to use it due to longitudinal size of the aneurysm [14]. Moreover, multicentre study of Lachat et al [21] showed that 25% of patients who had above-mentioned techniques, at the time of discharge had endoleaks type I and III. Though during follow-up most of the leaks thrombosed spontaneously, it was considerable risk of postoperative rupture of 11-cm aneurysm in early period.…”

The Gore Hybrid Vascular Graft in renovisceral debranching for complex aortic aneurysm repair

“…Additional visceral vessels were addressed in nine (69%) of these patients with chimney/periscope graft 14,15 (13 vessels), Viabahn Open Revascularization Technique 16 (2 vessels), and end-to-side anastomosis (2 vessels; Fig 1).…”