Comparison of Standard Endovascular Repair and Chimney Graft for Juxtarenal Abdominal Aortic Aneurysm

Abstract

Objective: This study compared the efficacy of standard grafting (S-EVAR) and chimney grafting (Ch-EVAR) for treating juxtarenal abdominal aortic aneurysms (JAAA).Methods: Data of patients with JAAA, who underwent S-EVAR and Ch-EVAR from January 2015 to December 2021, were collected. Follow-up was performed by CTA and intravascular ultrasonography of the aorta was performed before discharge, at 6 and 12 months postoperatively, and annually thereafter. Main outcome measures: AAA-related mortality, type Ia endoleak and reoperation.Results: A total of 62 patients underwent S-EVAR and 23 underwent Ch-EVAR. The proportion of men who underwent S-EVAR (91.9%, 57/62) was higher than the proportion who underwent Ch-EVAR (69.6%, 16/23) (p = 0.023). The postoperative incidence rate of type Ia endoleak was lower in S-EVAR (9.7% vs. 13%, p = 0.698). Times for hospitalization, ICU monitoring, operation, and anesthesia, and perioperative bleeding were less in S-EVAR (12 vs. 17 days, 0 vs. 1 day, 122.5 vs. 220 min, 177.5 vs. 300 min, 50 vs. 100 mL, p < 0.05). In S-EVAR, a suprarenal aortic angle was associated with type Ia endoleak (p = 0.016). Median follow-up duration was 48 months, (range, 0-94 months) in the S-EVAR group and 42 months (range, 0-90 months) in the Ch-EVAR group. 1-year survival rate were (91.9% vs. 91.3%), 3-year survival rate (81.7% vs. 78.7%), 5-year survival rate (62.2% vs. 45.8%) were not statistically different. No significant differences were found in postoperative complications. The long-term patency rate of chimney stent was 100%. Conclusions:The off-label use of S-EVAR for JAAA, with a straight and 8-10 mm aortic neck length, can be considered safe and effective. Ch-EVAR is more suitable for JAAA with excessive twisting of the neck (suprarenal aortic angle < 114°). In this study, long-term data of both technologies showed satisfactory results in preventing aneurysm rupture and the related mortality.