Early Experience with Snorkels and Chimneys for Expanding the Indications for Use of Endovascular Aneurysm Repair

Abstract

Although fenestrated and branched devices for juxtarenal and paravisceral aneurysms are available worldwide, limited ultrasound availability has perpetuated widespread utilization of adjunctive techniques for the endovascular treatment of these aneurysms. The objective of the study is to report on the technical feasibility and short-term durability of parallel grafts for juxtarenal and paravisceral aneurysms. We performed a retrospective review of a prospectively collected endovascular aneurysm repair database, including all patients who underwent a parallel stent procedure. End points included were the following: (1) number of vessels snorkeled; (2) endoleaks; (3) morbidity and mortality; and (4) snorkel graft patency. Forty patients (85% male, mean 77.8years) were treated for primary aneurysms (26), para-anastomotic aneurysms (6) following prior open repair, and endoleaks (8) following prior endovascular repair. Sixty-nine visceral vessels were preserved. Bilateral femoral arteries were accessed, as well as the left upper extremity via percutaneous (n=5) brachial, open brachial (n=15), or open axillary (n=20) artery exposure with conduit. The mean length of surgery was 253min with median intensive care unit stay of 2days. There were 6 endoleaks noted, 8 access site complications, 1 perioperative death, and 3 branch vessel stent occlusions. We have a mean follow-up time of 17.6months (range 3-44). Parallel stent-graft repair for paravisceral aneurysms is feasible and has acceptable technical/clinical success and complication rates. Although long-term follow-up is still needed, this technique fills the gap in endovascular options for poor open surgical candidates in whom fenestrated devices are not available.