AAN 11. Endovascular Aneurysm Sealing With Chimney Grafts—Outcomes from the First 77 Cases at a Single Institution

Abstract

Chimney grafts are placed parallel to an aortic stent graft to maintain perfusion through visceral branches. When they are used in combination with conventional endovascular aneurysm repair (EVAR), there is a significant risk of type I endoleak due to “guttering.” In combination with endovascular aneurysm sealing (EVAS), this risk is likely to be reduced because the polymer within the endobags conforms to the shape of the chimney stents while maintaining a proximal seal at the aneurysm neck. EVAS with chimney stents (ChEVAS) may therefore represent an alternative to fenestrated EVAR for the treatment of juxtarenal abdominal aortic aneurysms. Detailed preoperative, perioperative, and postoperative data were collected for each patient undergoing the ChEVAS procedure. There were 77 patients (82% male) with a mean age of 75.2 years studied. All patients had juxtarenal or suprarenal aneurysms; 33 patients were treated with one chimney stent, 26 with two, and 18 with three. Chimney stent patency was 97.8%. Reintervention was required in 9.1% of cases; 13.4% of cases have developed type IA endoleak, 10.4% demonstrated migration of the aortic stents, and 3.0% have seen secondary rupture. Aneurysm-related mortality and all-cause mortality were 7.5% and 22.4% respectively. ChEVAS is an effective treatment of juxtarenal abdominal aortic aneurysms, particularly for those patients with aneurysms unsuitable for fenestrated EVAR or those requiring urgent treatment. These data form part of the international, multicenter Aneurysm Study for Complex AAA: Evaluation of Nellix Durability (ASCEND) registry, results from which will allow us to determine the long-term efficacy of this new approach.