Abstract
ObjectivesGiven the similarities between coronary ostia and renal arteries, chimney grafts (CG) for kidney perfusion during abdominal endovascular aneurysm repair (EVAR) can be considered for coronary perfusion in future transcatheter aortic root repair (TARR) techniques. We analysed the results of renal CG and compared anatomic and technical details with root and coronary anthropometric data.MethodsCurrent status of kidney perfusion with CG was reviewed from literature. Anatomic details, technical data, CG performance and clinical outcome were collected and analysed. Anatomic details of aortic landing zone and renal arteries were compared with human anthropometric data of aortic root, ascending aorta and coronary ostia.ResultsSeventeen articles reported 430 patients (mean age:74.5 ± 2.9 years) treated with renal CG. Mean length and diameter of proximal landing zone were 2.0 ± 2.0 mm and 26.4 ± 4.3 mm, respectively (anthropometric correspondence: ascending aorta diameter of 29.3 mm). Aortic endograft mean diameter was 26.4 ± 7.3 mm with reported oversize of 19.5 ± 6.0%. In total, 590 renal arteries were treated (left:325; right:265; bilateral:139 cases). Mean left and right renal artery diameters were 5.7 ± 0.6 mm and 5.8 ± 0.7 mm, respectively (anthropometric correspondence: coronary ostia diameters of 4.8 mm (left) and 3.7 mm (right)) with reported CG oversize of 19.75 ± 6% (left) and 18.1 ± 5.1% (right). Mean follow-up time was 16.5 ± 8.5 months, CG occlusion rate was 3.2% and endoleak I or II was reported in 83 patients (19.3%), requiring 7 procedures.ConclusionsCG provides satisfactory results in patients with suitable renal artery diameter. Based on aortic root and coronary anthropometric data, CG can be considered in future TARR technologies for coronary perfusion but further tests for flow evaluations are mandatory.
Highlights
Recent reports showed that endovascular techniques for non-dissected ascending aorta diseases provide a period of stable conditions followed by new plans of more definitive treatments
Described by Greenberg et al, chimney grafts (CG) were firstly employed as bailout procedures during abdominal aorta endovascular aneurysm repairs (EVAR) and balloon-expanding stents were used to preserve the renal flow after the endoprosthesis deployment [2]
In order to identify published articles describing renal CG during EVAR, we searched in MEDLINE up to June 2019 using medical subject headings (MeSH) and text words supplemented by scanning the bibliographies of recovered articles including “chimney stent grafts”, “chimney technique”, “chimney graft”, “chimney stent”, “chimney”, “snorkel”, “chimney EVAR”, “renal artery” and using the Boolean operator “AND”
Summary
Recent reports showed that endovascular techniques for non-dissected ascending aorta diseases provide a period of stable conditions followed by new plans of more definitive treatments. In a review of 67 high-risk patients, Ferrari et al Journal of Cardiothoracic Surgery (2020) 15:132 challenge for the development of this technology is the way the coronaries are perfused. Described by Greenberg et al, chimney grafts (CG) were firstly employed as bailout procedures during abdominal aorta endovascular aneurysm repairs (EVAR) and balloon-expanding stents were used to preserve the renal flow after the endoprosthesis deployment [2]. Results from the PERICLES registry (898 renal CG in 517 patients) showed a success rate of 97%, mortality of 3.6%, and a CG patency of 94% at 17-month followup time [3]. They concluded that CG provide a safe and effective “off-the-shelf” solution in complex EVAR procedures. In order to verify the adaptability of CG to TARR we (1) reviewed the available literature on renal CG during EVAR, (2) investigated anatomic landmarks, technical details and outcome of renal CG, and (3) compared anatomic data of the descending aorta to anthropometric data of the aortic root
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