Fenestrated and Chimney Endografts for Juxtarenal Aneurysms: Early and Midterm Results

Suominen, Velipekka; Pimenoff, Georg; Salenius, Juha

doi:10.1177/1457496913490464

Cited by 21 publications

(8 citation statements)

References 24 publications

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“…The results in the existing literature include a report from our own group, with similar findings in early follow-up 7 . Despite the generally positive tone of most publications, several series have reported postoperative complication rates ranging from 0–35% 8, 20–22 . Eight(20%) patients in this study experienced postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Critical analysis of results after chimney endovascular aortic aneurysm repair raises cause for concern

Scali

Feezor

Chang

et al. 2014

Journal of Vascular Surgery

102

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Objective Chimney” techniques used to extend landing zones for endovascular aortic repair(chEVAR) have been increasingly reported; however, concerns about durability and patency remain. The purpose of this analysis was to examine mid-term outcomes of chEVAR. Methods All patients at the University of Florida treated with chEVAR were reviewed. Major adverse events(MAEs) were recorded and defined as any chimney stent thrombosis, type 1a endoleak in follow-up, reintervention, 30-day/in-hospital death and/or ≥ 25% decrease in estimated glomerular filtration rate after discharge. Primary end-points included chimney stent patency and freedom from MAE. Secondary end-points included complications and long-term survival. Results From 2008–2012, 41 patients[age ± standard deviation(SD); 73±8; male 66%(N=27)] were treated with a total of 76 chimney stents(renal, N=51; superior mesenteric artery, N=16 celiac artery, N=9) for a variety of indications: juxtarenal, 42%(N=17, 1 rupture); suprarenal, 17%(N=7), and thoracoabdominal aneurysm, 17%(N=7); aortic anastomotic pseudoaneurysm, 15%(N=6; 3 ruptures), type 1a endoleak after EVAR, 7%(N=3), and atheromatous disease, 2%(N=1). Two patients had a single target vessel abandoned due to cannulation failure and one had a type 1a endoleak at case completion(technical success = 93%). Intraoperative complications occurred in 7 patients(17%), including graft maldeployment with unplanned mesenteric chimney(N=2) and access vessel injury requiring repair(N=5). Major postoperative complications developed in 20%(N=8). 30-day and in-hospital mortality were 5%(N=2) and 7%(N=3), respectively. At median follow-up of 18.2(range 1.4–41.5) months, 28 of 33(85%) patients with available postoperative imaging experienced stabilization or reduction of AAA sac diameters. Nine(32%) patients developed endoleak at some point during follow-up [type 1a, 7%(N=3); type 2, 10%(N=4); indeterminate, 7%(N=3)], and one patient underwent open, surgical conversion. The estimated probability of freedom from reintervention(±standard error mean) was 96±4% at both 1 and 3 years. Primary patency of all chimney stents was 88±5% and 85±5% at 1 and 3 years, respectively. Corresponding freedom from MAEs was 83±7% and 57±10% at 1 and 3 years. The 1 and 5-year actuarial estimated survival for all patients was 85±6% and 65±8%, respectively. Conclusions These results demonstrate that chEVAR can be completed with a high degree of success; however perioperative complications and MAEs during follow-up, including loss of chimney patency and endoleak may occur at a higher rate than previously reported. Elective use of chEVAR should be performed with caution and comparison to open and/or fenestrated EVAR is needed to determine long-term efficacy of this technique.

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Section: Discussionmentioning

confidence: 99%

Critical analysis of results after chimney endovascular aortic aneurysm repair raises cause for concern

Scali

Feezor

Chang

et al. 2014

Journal of Vascular Surgery

102

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“…Previously published series have shown 30-day mortality rates for fEVAR ranging from 1.4% to 4.1%. 7,20 Banno et al 5 reported similar 30-day mortality for fEVAR and chEVAR at 6.3% and 7.9%, respectively. ESAR offers patients who might otherwise only be considered for complex endovascular repair a less technically demanding endovascular alternative for shortneck AAA.…”

Section: Discussionmentioning

confidence: 90%

“…Based on core laboratory assessment, the type IA endoleak rate of 6.8% at 1 month after ESAR is on par with alternative endovascular repair options in this complex anatomy. 20 Contemporary studies of fEVAR have reported type IA endoleak rates between 0% and 3.6%, but they have been as high as 7.1% in early reports. 5,21 Similarly, type IA endoleak after chEVAR ranges from 0% to 7.7% in several studies.…”

Section: Discussionmentioning

confidence: 98%

Endosuture aneurysm repair in patients treated with Endurant II/IIs in conjunction with Heli-FX EndoAnchor implants for short-neck abdominal aortic aneurysm

Arko

Stanley

Pearce

et al. 2019

Journal of Vascular Surgery

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Objective: Endovascular repair of abdominal aortic aneurysm (AAA) remains a challenging clinical scenario when there is a short or nonexistent segment of healthy infrarenal aorta. This study sought to determine the safety and effectiveness of endosuture aneurysm repair (ESAR) using the Endurant II/IIs endograft (Medtronic Vascular, Santa Rosa, Calif) in conjunction with Heli-FX EndoAnchors (Medtronic Vascular) in the treatment of short-neck AAA.Methods: In this subgroup analysis, 70 patients were identified from the Aneurysm Treatment Using the Heli-FX EndoAnchor System Global Registry (ANCHOR) who had an infrarenal neck length <10 mm down to 4 mm based on core laboratory measurements. Primary outcomes included technical success of the index procedure, rate of type IA endoleak at 1 month and 12 months, and rate of secondary procedures at 12 months.Results: In this short-neck cohort (n ¼ 70), the average neck length and diameter were 6.9 6 1.6 mm and 25.7 6 4.0 mm, respectively. Investigators reported an overall procedural success rate of 97.1% and a technical success rate of 88.6%. The duration of the implant procedure, EndoAnchor implantation, and total fluoroscopy time was 148.0 6 80.0 minutes, 17.1 6 11.5 minutes, and 35.3 6 22.0 minutes, respectively, and an average of 5.5 6 2.1 EndoAnchors were implanted per patient. Through the 30-day follow-up, type IA endoleaks were reported in four patients, of which three resolved spontaneously by the 12-month follow-up. There was an additional type IA endoleak through the 12-month follow-up that has not resulted in AAA enlargement or required a secondary procedure. The Kaplan-Meier estimate for freedom from secondary endovascular procedures and all-cause mortality is 95.4% and 92.7% through 365 days, respectively. No patient in the short-neck cohort experienced main body stent migration, increase in maximum aneurysm diameter, or aneurysm rupture or required conversion to open surgical repair through 12 months. Conclusions:In this analysis of the short-neck cohort from ANCHOR, the Endurant II/IIs endograft in conjunction with Heli-FX EndoAnchor implants (ESAR) appears to be a safe and effective treatment option with a high technical success rate and low incidence of type IA endoleaks and secondary interventions. Despite the complex and hostile anatomies, the ESAR method required short procedure and fluoroscopy times. These short-term outcomes suggest that ESAR could be complementary to therapies currently available for treatment of hostile AAA anatomy and a viable off-the-shelf endovascular treatment option for patients with short-neck AAAs, although long-term follow-up is critically important. (J Vasc Surg 2019;70:732-40.)

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“…Four trials 18,27,33,38 were included in the meta-analysis. The outcomes of technical success, 30-day mortality, types I and II endoleaks, target organ dysfunction, vascular restenosis/occlusion and re-intervention were analyzed (Figure 3).…”

Section: Resultsmentioning

confidence: 99%

Treatment of complex aortic aneurysms with fenestrated endografts and chimney stent repair: Systematic review and meta-analysis

et al. 2016

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Objective We reviewed data pertaining to fenestrated endograft technique and chimney stent repair of complex aortic aneurysm for comparative analysis of the outcomes. Methods A comprehensive search of relevant databases was conducted to identify articles in English, related to the treatment of complex aortic aneurysm with fenestrated endovascular aneurysm repair and chimney stent repair, published until January 2015. Results A total of 42 relevant studies and 2264 patients with aortic aneurysm undergoing fenestrated endovascular aneurysm repair and chimney stent repair were included in our review. A total of 4413 vessels were involved in these processes. The cumulative 30-day mortality was 2.4% and 3.2% ( p = 0.459). The follow-up aneurysm-related mortality was 1.4% and 3.2% ( p = 0.018), and target organ dysfunction was 5.0% and 4.0% in fenestrated endovascular aneurysm repair and chimney stent repair, respectively ( p = 0.27). A total of 156 vessels showed restenosis or occlusion after primary intervention (3.6% and 3.4% in fenestrated endovascular aneurysm repair and chimney stent repair, respectively, p = 0.792). The cumulative type I endoleak was 2.0% (38/1884) after fenestrated endovascular aneurysm repair compared with 3.4% (13/380) after chimney stent repair ( p = 0.092), and the type II endoleak was 5.4% (102/1884) and 5.3% (20/380), respectively ( p = 0.905). Approximately, 1.1% and 1.6% increase in aneurysm was observed following fenestrated endovascular aneurysm repair and chimney stent repair, respectively ( p = 0.437). The re-intervention frequency was 205 and 19 cases after fenestrated endovascular aneurysm repair and chimney stent repair, respectively (11.7%, 5.6%, p = 0.001). Conclusions Fenestrated endovascular aneurysm repair and chimney stent repair are safe and effective in treating patients with complex aortic aneurysm. A higher aneurysm-related mortality was observed in chimney stent repair while fenestrated endovascular aneurysm repair was associated with a higher re-intervention rate.

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Fenestrated and Chimney Endografts for Juxtarenal Aneurysms: Early and Midterm Results

Abstract: The treatment of juxtarenal aortic aneurysms seems to be feasible by exploiting various endovascular techniques. Even with a low volume of cases, good immediate and short-term results can be achieved, especially with fenestrated endografts.

Cited by 21 publications

References 24 publications

Critical analysis of results after chimney endovascular aortic aneurysm repair raises cause for concern

Critical analysis of results after chimney endovascular aortic aneurysm repair raises cause for concern

Endosuture aneurysm repair in patients treated with Endurant II/IIs in conjunction with Heli-FX EndoAnchor implants for short-neck abdominal aortic aneurysm

Treatment of complex aortic aneurysms with fenestrated endografts and chimney stent repair: Systematic review and meta-analysis

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