Application of renal artery chimney graft in endovascular repair for abdominal aortic aneurysm

Abstract

Objective To assess the safety and efficacy of renal artery chimney graft in endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) with complex aneurysm neck. Method From September 2013 to September 2015, a total of 7 AAA patients with complex aneurysm neck were treated by EVAR with extension of proximal aneurysm neck by renal artery chimney graft in our center. There were 4 cases with proximal aneurysm neck longer than 10 mm, and 3 cases shorter than 10 mm. Results The length of the proximal aneurysm neck was (12.7±5.2) mm, and the angulation of the proximal aneurysm neck was (68.6± 14.6) °. During the procedure of one case, the main stent graft migrated to the aneurysmal sac, a renal chimney graft was then used to extend the proximal landing zone, followed by implantation of a cuff, which eliminated the endoleak. Obvious type I endoleak after deployment of stent grafts was found in 3 patients, in whom renal artery chimney graft was applied to prolong the proximal landing zone, followed by implantation of a cuff, which significantly decreased the endoleak. Left, right, and bilateral renal arteries were reconstructed by chimney graft in 5, 1, and 1 patient, respectively. There was no 30-day mortality. During a mean follow-up of 16.6 months, there was no mortality, while there was 1 femoral access infection, 1 branchial artery pseudoaneurysm, and 1 groin hematoma within 30 days. Persistent minor endoleak was observed in 1 patient at 1 year follow up. All the 8 chimney grafts remained patent. Conclusion For AAA with short neck and large angulation, preoperatively planned or provisional renal artery chimney graft based on intraoperative proximal endoleak can effectively prolong proximal landing zone and facilitate the EVAR procedure, and is safe and effective during short- to mid-term follow-up, while long-term follow-up is needed. Key words: Key words: Chimney graft, Endovascular aneurysm repair, Endoleak