New Chimney after Chimney EVAR for the Treatment of Type Ia Endoleak

Abstract

The chimney graft (CG) technique can be a useful alternative in treating aortic aneurysms with challenging anatomy, regarding the proximal sealing zone. We describe the case of a patient who developed a type Ia endoleak after chimney endovascular aneurysm repair for a juxtarenal AAA and underwent a proximal CG reconfiguration and implantation of an aortic cuff. The crossing configuration of the CGs should be avoided as it may compromise the circumferential apposition of the endograft and impede the thrombosis of the perigraft gutters. A proximal reconfiguration of the CGs, in case of type Ia endoleak is a useful option. The long-term efficacy of this option should be evaluated by meticulous follow-up.

Keywords

abdominal aortic aneurysm - aneurysm - celiac artery embolism - endovascular approach - endovascular repair - mesenteric artery

• References

• 1 Lachat M, Veith FJ, Pfammatter T , et al. Chimney and periscope grafts observed over 2 years after their use to revascularize 169 renovisceral branches in 77 patients with complex aortic aneurysms. J Endovasc Ther 2013; 20 (5) 597-605
• 2 Greenberg RK, Clair D, Srivastava S , et al. Should patients with challenging anatomy be offered endovascular aneurysm repair?. J Vasc Surg 2003; 38 (5) 990-996
• 3 Moulakakis KG, Mylonas SN, Avgerinos E , et al. The chimney graft technique for preserving visceral vessels during endovascular treatment of aortic pathologies. J Vasc Surg 2012; 55 (5) 1497-1503
• 4 Tolenaar JL, Zandvoort HJ, Moll FL, van Herwaarden JA. Technical considerations and results of chimney grafts for the treatment of juxtarenal aneursyms. J Vasc Surg 2013; 58 (3) 607-615
• 5 Shuja F, Kwolek CJ. Treating the paravisceral aorta with parallel endografts (chimneys and snorkels). Semin Vasc Surg 2012; 25 (4) 200-202
• 6 Schlösser FJ, Aruny JE, Freiburg CB, Mojibian HR, Sumpio BE, Muhs BE. The chimney procedure is an emergently available endovascular solution for visceral aortic aneurysm rupture. J Vasc Surg 2011; 53 (5) 1386-1390
• 7 Jordan Jr WD, Mehta M, Varnagy D , et al; Aneurysm Treatment using the Heli-FX Aortic Securement System Global Registry (ANCHOR) Workgroup Members. Results of the ANCHOR prospective, multicenter registry of EndoAnchors for type Ia endoleaks and endograft migration in patients with challenging anatomy. J Vasc Surg 2014; 60 (4) 885-892.e2
• 8 Niepoth WW, de Bruin JL, Yeung KK , et al. A proof-of-concept in vitro study to determine if EndoAnchors can reduce gutter size in chimney graft configurations. J Endovasc Ther 2013; 20 (4) 498-505
• 9 Moulakakis KG, Papapetrou A, Giannakopoulos TG , et al. The chimney graft technique for preserving renal arteries in stent-graft sealing zones. Vasa 2012; 41 (4) 295-300
• 10 Moulakakis KG, Sfyroeras GS, Kakisis JD , et al. Endograft infection and treatment with preservation of the endograft: early results in 3 cases. Ann Vasc Surg 2014; 28 (7) 1789.e1-1789.e7
• 11 Moulakakis KG, Sfyroeras GS, Mylonas SN , et al. Outcome after preservation of infected abdominal aortic endografts. J Endovasc Ther 2014; 21 (3) 448-455
• 12 Libicher M, Reichert V, Aleksic M, Brunkwall J, Lackner KJ, Gawenda M. Balloon occlusion of the celiac artery: a test for evaluation of collateral circulation prior endovascular coverage. Eur J Vasc Endovasc Surg 2008; 36 (3) 303-305
• 13 Schiro A, Antoniou GA, Ormesher D, Pichel AC, Farquharson F, Serracino-Inglott F. The chimney technique in endovascular aortic aneurysm repair: late ruptures after successful single renal chimney stent grafts. Ann Vasc Surg 2013; 27 (7) 835-843