Mid-term Results of Chimney and Periscope Grafts in Supra-aortic Branches in High Risk Patients

Abstract

WHAT THIS PAPER ADDSThe use of chimney and periscope grafts for the treatment of aneurysms involving the supra-aortic branches is reported with mid-term follow-up. This tool uses off the shelf devices and it can be employed in the emergency setting. This single centre experience reports the use of self expandable covered stents for parallel graft construction with particular attention to a standardised technique. The limited experience and follow-up available allow the use of this technique in high risk patients unfit for conventional surgery.Purpose: Report mid-term outcomes of thoracic endovascular aneurysm repair (TEVAR) with chimney and periscope grafts (CPG) in supra-aortic branches (SAB). Methods: Retrospective analysis, from October 2009 to May 2014, of patients with aneurysms requiring TEVAR with zone 0/1/2 proximal landing in association with at least one CPG in the SAB. All patients were considered at high risk for conventional surgery. Peri-operative mortality and morbidity, retrograde type A dissection, maximum aortic transverse diameter (TD) and its post-operative evolution, endoleak, survival, freedom from cardiovascular re-interventions, and CPG freedom from occlusion during the follow-up were analysed. Results: Forty-one patients (28.05% EuroScore II) with thoraco-abdominal aortic aneurysm (17%), arch aneurysm (39%), descending aneurysm (34%), and aneurysm extending from the arch to the visceral aorta (10%) were included. Fifteen (37%) patients were treated non-electively. Fifty-nine SABs were treated with the CPG technique: one, two, three, and four CPG were employed in 71%, 19%, 5%, and 5% of patients, respectively. The proximal landing was in zone 0 in 49% of patients, zone 1 in 17%, and zone 2 in 34%. Technical success was 95%. Peri-operative complications and neurological events were registered in six (14.6%) patients and there were 5 deaths (12%). At a median follow-up of 21.2 (mean 22, SD 18; range 0e65) months, type I/III endoleaks were registered in three (7%) cases and re-intervention in six (15%) patients. A significant aneurysm sac shrinkage (p<.001) was reported at mean follow-up and no significant aneurysm sac increase (>5 mm). The estimated 2 year survival, freedom from re-intervention, freedom from endoleak, and freedom from branch occlusion were 75%, 77%, 86%, and 96%, respectively. Conclusion: The chimney and periscope grafts technique was shown to be safe in aortic aneurysm disease involving the supra aortic branches, even in an emergency setting using off the shelf devices. Mid-term follow-up results in this high risk population are good, but longer follow-up is mandatory before this technique is used in intermediate-risk patients. Ó

Endovascular repair of an abdominal aortic aneurysm associated with crossed fused renal ectopia

“…Stent graft sizing was performed using the Lachat formula. 3 The diameters of the aortic landing zone and the parallel graft were 25.5 mm and 5 mm, respectively. Therefore, we chose a 28-mm stent graft (ETBF 28-13-145 Endurant; Medtronic, Minneapolis, Minn).…”

Hybrid Aortic Arch Repairs

“…Pecoraro et al 16) reported the results of parallel graft techniques in 41 patients. About 50% (20) of the patients required zone 0 landing; however, there was no patient of Type Ia endoleak.…”

Evaluation of EndoAnchor Aortic Wall Penetration After Thoracic Endovascular Aortic Repair

“…Mid-and long-term results in large series demonstrate durability in anatomically suitable patients; however, reinterventions due to loss of proximal and distal seal compromise procedure success and stability. 2 Several endovascular techniques have been described to improve the length of seal in the proximal landing zone, such as use of chimneys and periscopes, 3,4 scallops, 5 fenestrations, 6,7 and branches. 8,9 In terms of arch and thoracic aortic anatomical parameters, angulation 10 and adequate seal zone length (>20 mm) and diameter (<40 mm) have been described as mandatory to achieve adequate seal in the proximal landing zone.…”