The chimney graft technique for preserving renal arteries in stent-graft sealing zones

Abstract

Patients with juxtarenal aneurysms require complex surgical open repair, which is associated with increased mortality and morbidity. An alternative procedure that can be used is the "chimney graft" technique. Three cases of abdominal aortic aneurysms were successfully treated in our department with this technique. One type-Ia endoleak occurred which was successfully treated with coiling and biological glue infusion. All of the chimney grafts have remained patent for the period of observation. The "chimney" technique has good results as a bail out procedure in complex EVAR or in well planned difficult cases. Long-term data is necessary to determine the efficacy of this technique.

Systematic review of chimney and periscope grafts for endovascular aneurysm repair

“…In total, 234 patients underwent aortic grafting (either chimney/snorkel or periscope technique) for 22 4 4 : 0 4 0 : 4 n.a. 11 (7)(8)(9)(10)(11)(12)(13)(14) 4 (100) 0 (0) Rancic et al 23 2 2 : 0 4 0 : 2 152 6 4 (100) 1 (50) Lachat et al 24 1 1 : 0 4 0 : 1 75 6 4 (100) 1 (100) Schlosser et al 25 1 0 : 1 2 0 : 1 n.a. 6 2 (100) 1 (100) Richardson et al 26 1 1 : 0 1 0 : 1 48·7 5 1 (100) 0 (0) Ketelsen et al 27 1 1 : 0 Values in parentheses are *ranges and †percentages.…”

“…Ohrlander et al 11 6 0 (0) 1 mesenteric ischaemia (t) 11 (100) 1 (1) 1 0 Moulakakis et al 12 3 0 (0) 0 4 (100) 0 0 0 Pecoraro et al 13 3 1 (33) 0 7 of 8 (88) 0 0 1 type I endoleak (t) Allaqaband et al 14 2 0 (0) 0 2 (100) 0 0 0 Brechtel et al 15 1 0 (0) 0 4 (100) 0 0 0 Tan et al 16 1 0 (0) Laparotomy to close enteric defect 2 (100) 0 0 0…”

Upper extremity access for fenestrated endovascular aortic aneurysm repair is not associated with increased morbidity

“…An endoleak rate of 13% to 25%, most of which are type Ia, has been reported given the lack of complete graft apposition to the aortic wall and the presence of gutters around the visceral stents that run alongside the aortic graft. 15,16,[19][20][21] These gutters often require additional procedures for repair. 21 Snorkel and chimney grafts have also been associated with an increased risk of stroke in the range of 3% to 10%.…”

Extra-anatomic Endovascular Repair of an Abdominal Aortic Aneurysm with a Horseshoe Kidney Supplied by the Aneurysmal Aorta

“…10 Established endovascular options for repair could have included surgeon-modified (''custom'') fenestrated endografting, attempting a chimney or snorkel-type repair, or operative debranching before placement of an endograft. 8,9,12 In this 83-year-old patient with severe chronic obstructive pulmonary disease leading to 2 recent hospital admissions, open repair would have necessitated proximal (potentially supravisceral) aortic clamping and reimplantation of the right renal artery. The complex endovascular repair chosen for this patient not only prevented him from undergoing an open surgery but also preserved his kidney function.…”