Objective

In the treatment of pararenal abdominal aortic aneurysms and aortic pathologic processes, chimney endovascular aneurysm repair (CHEVAR) represents an alternative technique for urgent cases. The aim of the study was to evaluate the outcomes of CHEVAR in the elective setting.

Methods

We performed a retrospective analysis of prospectively collected records of 165 consecutive asymptomatic CHEVAR patients who were treated between March 2009 and January 2018 with the Endurant stent graft (Medtronic, Santa Rosa, Calif). A total of 244 chimney grafts (CGs) were implanted. The primary end point was clinical success, defined as freedom from procedure-related mortality, persistent type IA endoleak, occlusion or high-grade stenosis (>70%) of CGs, and any chimney technique-related secondary procedure for the entire follow-up period. Secondary clinical success included patients with successful treatment of a primary end point with a secondary endovascular procedure.

Results

All 244 targeted chimney vessels were successfully cannulated. Total perioperative morbidity was 7.8% (n = 13), including 3 (1.8%) cases of bowel ischemia, 1 (0.6%) patient with renal ischemia, and 1 patient (0.6%) with stroke. Median follow-up was 25.5 ± 2.2 months. Both 30-day and follow-up procedure-related mortality rates were 1.8% (n = 3). Primary and secondary freedom from persistent type IA endoleak rates were 96.4% (n = 159) and 99.4% (n = 164), respectively. Primary and secondary CG patency rates were 92.2% (n = 225) and 95.9% (n = 234), respectively. The rate of reinterventions related to the chimney technique was 10.9% (n = 18), and 83.3% of them were performed by endovascular means. The estimated cumulative primary patency and freedom from persistent type IA endoleak were 87.5% and 95.3%, respectively, and the primary and secondary clinical successes rates at midterm were 80.3% and 87.5%, respectively.

Conclusions

The elective use of CHEVAR with the Endurant stent graft in our series showed favorable midterm clinical results, which are similar to the published results of other total endovascular modalities. A prospective randomized trial of elective treatment of pararenal abdominal aortic aneurysms and aortic pathologic processes with current endovascular options is needed to assess the value of CHEVAR in the elective setting.

中文翻译：

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在肾旁主动脉病理过程中选择性使用烟囱血管内技术的结果。

客观的

在治疗肾旁腹主动脉瘤和主动脉病理过程中，烟囱血管内动脉瘤修复 (CHEVAR) 是紧急病例的替代技术。该研究的目的是评估 CHEVAR 在选择性环境中的结果。

方法

我们对 2009 年 3 月至 2018 年 1 月期间接受 Endurant 覆膜支架（美敦力，加利福尼亚州圣罗莎）的 165 名连续无症状 CHEVAR 患者的前瞻性收集记录进行了回顾性分析。总共植入了 244 个烟囱移植物 (CG)。主要终点是临床成功，定义为无手术相关死亡率、持续性 IA 型内漏、闭塞或严重狭窄 (>70%) CGs，以及整个随访中任何与烟囱技术相关的二次手术时期。次要临床成功包括通过次要血管内手术成功治疗主要终点的患者。

结果

所有 244 个目标烟囱血管均成功插管。围手术期总发病率为 7.8% (n = 13)，包括 3 (1.8%) 例肠缺血、1 (0.6%) 例肾缺血和 1 例 (0.6%) 中风。中位随访时间为 25.5 ± 2.2 个月。30 天和后续手术相关的死亡率均为 1.8%（n = 3）。原发性和继发性 IA 型内漏率分别为 96.4% (n = 159) 和 99.4% (n = 164)。一级和二级 CG 通畅率分别为 92.2% (n = 225) 和 95.9% (n = 234)。与烟囱技术相关的再干预率为 10.9%（n = 18），其中 83.3% 是通过血管内方式进行的。估计的累积主要通畅率和持续性 IA 型内漏率分别为 87.5% 和 95.3%，

结论

在我们的系列中选择性使用 CHEVAR 和 Endurant 覆膜支架显示出良好的中期临床结果，这与其他全血管内方式已发表的结果相似。需要一项前瞻性随机试验，对肾旁腹主动脉瘤和主动脉病理过程采用当前血管内治疗进行选择性治疗，以评估 CHEVAR 在选择性治疗中的价值。