Chimney and Periscope Grafts Observed Over 2 Years After Their Use to Revascularize 169 Renovisceral Branches in 77 Patients With Complex Aortic Aneurysms

Felice Pecoraro, Steffen Gloekler, Frank J. Veith, Mario Lachat, Dominique Bettex, Michael Glenck, Zoran Rancic, Thomas Pfammatter, Dieter Mayer

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88 Citations (Scopus)

Abstract

Purpose: To evaluate the performance of periscope and/or chimney grafts (CPGs) in theendovascular treatment of pararenal or thoracoabdominal aneurysms using off-the-shelfdevices.Methods: Between February 2002 and August 2012, 77 consecutive patients (62 men; meanage 7369 years) suffering from pararenal aortic (n¼55), thoracoabdominal (n¼16), or arch tovisceral artery aneurysms (n¼6) were treated with aortic stent-graft implantation requiringchimney and/or periscope grafts to maintain side branch perfusion. CPGs were planned inadvance and were not used as bailout. A standardized follow-up protocol includingcomputed tomographic angiography, laboratory testing, and clinical examination wasperformed at 6 weeks; 3, 6, and 12 months; and annually thereafter.Results: Technical success was achieved in 76 (99%) patients; 1 branch stent-graft becamedislocated from a renal artery, which could not be re-accessed. Overall, 169 target vessels(121 renal arteries, 30 superior mesenteric arteries, 17 celiac trunks, and 1 inferior mesentericartery) were addressed with the chimney graft configuration in 111 and the periscope graftconfiguration in 58. In total, 228 devices were used for the CPGs: 213 Viabahn stent-grafts and15 bare metal stents. Over a mean 25616 months (range 1–121), 9 patients died of unrelatedcauses. Nearly all (95%) of the patients demonstrated a decreased or stable aneurysm size onimaging; there was a mean 13% shrinkage in aneurysm diameter. Twenty patients hadprimary type I/III endoleaks at discharge; in follow-up, only 3 of these were still present (nosecondary or recurrent endoleaks were noted). Additional endovascular maneuvers wererequired for CPG-related complications in 13 patients fromintervention throughout follow-up.Overall, 4 CPGs occluded (98% target vessel patency); no stent-graft migration was observed.Renal function remained stable in all patients.Conclusion: In this series, the use of CPGs has proven to be a feasible, safe, and effective wayto treat thoracoabdominal and pararenal aneurysms with maintenance of blood flow to therenovisceral arteries. Nearly all of the aneurysms showed no increase in diameter over a .2-year mean follow-up, which supports the midterm adequacy of the CPG technique as amethod to effectively revascularize branch vessels with few endoleaks or branch occlusions.
Original languageEnglish
Pages (from-to)597-605
Number of pages9
JournalJournal of Endovascular Therapy
Volume20
Publication statusPublished - 2013

All Science Journal Classification (ASJC) codes

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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