Use of covered chimney stents for pararenal aortic pathologies is safe and feasible with excellent patency and low incidence of endoleaks

Felice Pecoraro, Martin Austermann, Giovanni Torsello, Giuseppe Panuccio, Felice Pecoraro, Konstantinos P. Donas, Mario Lachat, Zoran Rancic, Dieter Mayer

Risultato della ricerca: Articlepeer review

116 Citazioni (Scopus)

Abstract

Background: To present the clinical experience of consecutive series with use of balloon-expandable and self-expandingchimney endografts (balloon-expandable covered stent group [BECS] vs self-expanding covered stent group [SECS]) inthe endovascular treatment of challenging aortic pathologies requiring renal and/or visceral revascularization.Methods: Between January 2009 and May 2011, data for 37 high-risk patients from one center and 35 patients fromanother institution, with pararenal aortic pathologies treated by the chimney endovascular technique, were prospectivelycollected. The chimney-graft technique is based on the deployment of a covered or bare-metal stent parallel to the aorticendograft, thereby creating a conduit that runs outside the aortic main endograft, and has been proposed to ensure secureproximal fixation extending the sealing zones.Results: Forty-six consecutive target vessels (43 renal arteries and 3 superior mesenteric arteries) were revascularizedby the Advanta (Atrium, Hudson, NH) BECS (1.2 chimneys/patient); in contrast, 81 consecutive target vessels (64renal arteries, 11 superior mesenteric arteries, and 6 celiac trunks) were revascularized by the Viabahn (Gore,Flagstaff, Ariz) SECS (2.3 chimneys/patient). The success rate for target vessel preservation was 97.8% for the BECSgroup and 100% for the SECS group in the entire follow up. There was one symptomatic left renal artery occlusionof the BECS group treated by open thrombectomy of the left renal artery and placement of 8-mm Dacron (BBraun,Aesculap AG, Tuttlingen, Germany) iliorenal bypass. Additionally, one patient underwent repeat balloon angioplastywith a 5-mm balloon due to high-grade in-stent stenosis of a 6 59 Advanta stent graft 12 monthspostoperatively. Overall, one perioperative (and not present in the computed tomography angiography at discharge)type Ia endoleak was detected in the BECS group. In contrast, five perioperative type Ia endoleaks were present inthe SECS group; however, only one of them was persistent in the radiological imaging and was treated by proximalextension of a 5-mm cuff, 1 year postoperatively, due to continuous aneurismal sac increase. No patient of anysubgroup developed postoperative persistent renal insufficiency with need of hemodialysis. Thirty-day and duringthe follow-up procedure-related mortality was 0% for both BECS and SECS groups.Conclusions: In summary, midterm results of use of covered chimney stents for pararenal aortic pathologies show safetyand feasibility with excellent patency and low incidence of endoleaks.
Lingua originaleEnglish
pagine (da-a)659-665
Numero di pagine7
RivistaJournal of Vascular Surgery
Volume55
Stato di pubblicazionePublished - 2012

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

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