IF02. Surgical and Endovascular Treatment of Extracranial Carotid Artery Aneurysms: Early and Long-Term Outcome and Experience of a Single Center

Abstract

ducibility and the midterm results of the chimney/snorkel endovascular technique (ch-EVAR) in the treatment of type Ia endoleaks after standard EVAR. Methods: Between January 2008 and December 2014, 517 ch-EVAR abdominal procedures were performed in 13 United States and European vascular centers (PERICLES registry). Of these, 39 (25 men) were treated due to persistent type Ia endoleak after standard EVAR and had at least one radiologic postoperative follow-up with computed tomography angiography (CTA). Results: Mean age of the treated patients was 76.2 6 7.6, and all were classified as American Society of Anesthesiologists III or IV. Mean aneurysm diameter was 71.5 6 29.0 mm. Mean infrarenal neck length was 3.9 mm, requiring lengthening of the sealing zone by placement of chimney grafts. The newly created sealing zone increased to 21.2 mm. Operative variables are summarized in Table I. Endurant abdominal devices were used in 20 patients (51.3%). Single chimney graft placement was performed in 18 patients (46.1%) and multiple in 21 (53.9%). Overall, 70 visceral vessels were revascularized by chimney grafts. Operative outcomes are summarized in Table II. The 30-day mortality was 2.6% (1 cardiac death). Two other deaths occurred during the mean follow-up of 21.9 months due to nonaneurysm-related causes. Primary patency of the chimney grafts was 89.7%. Three type Ia endoleaks were detected. Two of them were treated conservatively by radiologic surveillance, and one, with an additional increase of the aneurysm sac of >5 mm, was treated invasively. No statistically significant difference was noted in from type Ia endoleak at follow-up between ch-EVAR performed by the Endurant device (1 of 20 [5%]) vs other devices (2 of 19 [10.5%]; P ¼ .6) as well in terms of reintervention (1 of 20 [5%] vs 0 of 19 [0%]; P ¼ 1.000), respectively. Conclusions: The present largest series in the literature regarding ch-EVAR in the treatment of type Ia endoleaks after previous EVAR showed reproducible results independent of the abdominal and chimney grafts combinations that were used. Longer follow-up is needed to ensure the durability of the present findings.