Early results of endovascular aneurysm sealing with chimney grafts to treat juxtarenal and suprarenal abdominal aortic aneurysms
| Autor: | Katherine Stenson, Benjamin O. Patterson, Matthew J. Grima, Peter J. Holt, Jorg L. de Bruin, Ian M. Loftus |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Endoleak 030204 cardiovascular system & hematology Prosthesis Design Blood Vessel Prosthesis Implantation 03 medical and health sciences 0302 clinical medicine Aneurysm London medicine Humans In patient 030212 general & internal medicine Aged Retrospective Studies Aged 80 and over Surgical repair Aneurysm morphology business.industry Open surgery Endovascular Procedures Chimney graft Mean age medicine.disease Blood Vessel Prosthesis Surgery Treatment Outcome Early results Retreatment Female Stents Cardiology and Cardiovascular Medicine business Aortic Aneurysm Abdominal |
| Zdroj: | Journal of Vascular Surgery. 70:43-52 |
| ISSN: | 0741-5214 |
| DOI: | 10.1016/j.jvs.2018.09.065 |
| Popis: | Background The treatment of juxtarenal abdominal aortic aneurysms is challenging. Open surgical repair is not a viable option for many patients. The use of endovascular aneurysm sealing (EVAS) with chimney grafts (Ch-EVAS) has been proposed as an immediately available, off-the-shelf option for individuals with juxtarenal aneurysms who require urgent treatment or are unsuitable for fenestrated or branched devices. This study reports the outcomes from our first patients to undergo this procedure. Methods Data were collected prospectively for 62 consecutive patients undergoing Ch-EVAS at our institution. The procedures were undertaken for intact juxtarenal or suprarenal aneurysms in patients who were unfit for open repair or needed urgent treatment or when the aneurysm morphology was unsuitable for treatment with fenestrated or branched endografts. Results Between July 2013 and June 2016, there were 62 patients who were treated with Ch-EVAS; 77.4% were male, and the mean age was 73.9 years. Median aneurysm diameter was 64.5 mm. Eight suprarenal aneurysms were treated, with three chimney grafts. Of 54 juxtarenal aneurysms treated, 21 cases used two chimney grafts and 33 cases used one chimney graft. Median follow-up was 407 days. Eleven patients underwent reintervention. There were five type IA endoleaks, all successfully treated. One type IB and one type II endoleak occurred, neither requiring treatment. There were four minor strokes. Chimney patency is 97%. Conclusions These results in a group of high-risk patients suggest that Ch-EVAS is a viable alternative to custom-made devices in patients who are unfit for open surgery. Longer term follow-up and data from the international registry will determine the widespread applicability and durability of this technique. |
| Databáze: | OpenAIRE |
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