Complementary Role of Fenestrated/Branched Endografting and the Chimney Technique in the Treatment of Pararenal Aneurysms After Open Abdominal Aortic Repair.
PURPOSE
To evaluate the totally endovascular techniques for treating complex pararenal aortic aneurysms after open repair of abdominal aortic aneurysm.


METHODS
This retrospective study involved 34 men (mean age 74 years) with pararenal aortic aneurysms (22 pseudoaneurysms and 12 para-anastomotic aneurysms) that developed a median 11 years (range 4-22) after the primary surgical reconstruction. The median infrarenal neck length was 2 mm (range 0-9). Total endovascular aneurysm repair (EVAR) included the use of fenestrated (f-EVAR; n=17), branched (b-EVAR; n=11), combined f-EVAR/b-EVAR (n=1), and chimney (ch-EVAR; n=4) grafts and the "sandwich" technique (n=1). The primary outcome was aneurysm shrinkage >5 mm at latest follow-up. Secondary outcomes were target vessel patency, 30-day mortality, late survival, absence of type I and III endoleak, clinical success, and reintervention rate.


RESULTS
Technical success was 97% (n=33/34), while clinical success was achieved in 32 (94%) patients. The 30-day mortality was 3% (n=1/34). Mean follow-up was 23.2±16.6 months. One patient was lost to follow-up, and 1 patient underwent late open conversion for endograft infection. Six (18%) of the 33 surviving patients required a reintervention. Primary patency of the target aortic branches was 98% (109/111). Mean aneurysm diameter decreased from 64.1±10.2 to 56.7±16.9 mm (p<0.001) at latest follow-up. Midterm mortality was 12.1% (4/33). Estimated survival rates at 1 and 2 years were 93.9% and 90.9, respectively.


CONCLUSION
Use of f-EVAR, b-EVAR, and ch-EVAR allows effective treatment of postsurgical pararenal aneurysms based on a clear algorithm and patient selection, highlighting the complementary character of these less invasive approaches.
['Reyes|Andrés|A|', 'Donas|Konstantinos P|KP|', 'Pitoulias|Georgios|G|', 'Austermann|Martin|M|', 'Gandarias|Claudio|C|', 'Torsello|Giovanni|G|']
D000368:Aged D017544:Aortic Aneurysm, Abdominal D001027:Aortography D001807:Blood Vessel Prosthesis D019917:Blood Vessel Prosthesis Implantation D000072226:Computed Tomography Angiography D057510:Endovascular Procedures D005260:Female D006801:Humans D053208:Kaplan-Meier Estimate D008297:Male D008875:Middle Aged D011183:Postoperative Complications D011474:Prosthesis Design D012086:Reoperation D012189:Retrospective Studies D012307:Risk Factors D015607:Stents D013997:Time Factors D016896:Treatment Outcome D018616:Ultrasonography, Doppler, Duplex D014654:Vascular Patency
chimney technique aneurysm target vessel patency reintervention branched stent-graft fenestrated stent-graft pararenal abdominal aorta sandwich technique