Multiple periscope and chimney grafts to treat ruptured thoracoabdominal and pararenal aortic aneurysms

Purpose: To report midterm outcomes after urgent endovascular repair of rupturedpararenal or thoracoabdominal aortic aneurysms using multiple periscope and chimneygrafts to preserve renovisceral branch perfusion and facilitate aneurysm exclusion.Methods: Nine consecutive men (mean age 72614 years, range 40–88) presenting withruptured thoracoabdominal (n56), pararenal (n52), or infrarenal (n51) aortic aneurysmunderwent urgent endovascular repair with at least 1 periscope graft delivered via atransfemoral access; chimney grafts were installed from an axillary access. In all, 17periscope and 7 chimney grafts were used to reperfuse 11 renal and 13 visceral arteries inthe 9 patients. The aortic aneurysms were excluded using thoracic devices (n57), an aorticextension cuff (n51), and bifurcated stent-grafts (n52).Results: All procedures were completed without technical complications except for adislocated stent-graft from the right renal artery; the artery could not be re-accessed, andthe right kidney was sacrificed. One patient died of multiple organ failure (11% 30-daymortality). At a mean follow-up of 10 months (range 3–24), 5 of the 9 patients hadrecovered completely; 3 patients died of unrelated causes. Imaging showed no aneurysmgrowth in any patient, with a mean 20% shrinkage in aneurysm size. All periscope andchimney grafts remained patent, and no aortic stent-graft migration was observed. Renalfunction and the glomerular filtration rate remained stable in all patients.Conclusion: The periscope and chimney graft technique provides a simpler, less invasiveway to maintain blood flow to the renovisceral arteries during urgent endovascular aorticrepairs. The very low 30-day mortality rate and the stability of the repairs in the midtermare encouraging. This technique has the potential to profoundly influence the treatment ofacute aortic pathologies.