Long Parallel Stent Grafts for the Treatment of Complex Aortic Aneurysms.

Abstract

To describe our experience with the chimney technique in endovascular aneurysm repair (ch-EVAR) using long parallel grafts (PGs) of 100mm or more for the treatment of complex aortic aneurysms. From 2009 to 2016, data were prospectively collected for patients who underwent ch-EVAR using long PGs. Data included patient demographics and aortic anatomy, technical success, patency and reintervention rate. A total of 29 long PGs were placed in 18 patients (males 16, average age 71years). Nine (50%) suffered from thoracoabdominal aortic aneurysms, 4 (22%) from juxtarenal aortic aneurysms and 3 (17%) from suprarenal aortic aneurysms and 2 (11%) were treated for abdominal aortic aneurysms that required revascularization of a pelvic kidney. Twenty (70%) of the PGs were 100mm in length, and 9 (30%) were 150mm. Long PGs were successfully placed in 16 (89%) patients. Two patients (11%) expired in the perioperative period. Mean period of follow-up was 12months (range 1-43months). Sac size decreased in size or remained unchanged in 13 patients (72%). Three patients with sac enlargement underwent successful endovascular treatment the type 1A gutter endoleaks. None required reintervention of the PGs. Three patients expired, none from aneurysm-related deaths. The use of long PGs is a feasible technique and provides a durable repair of complex aortic aneurysms in midterm follow-up. Despite the length of the PGs, gutter endoleaks are encountered only in a minority of the cases and can be treated minimally invasive techniques.