Abstract
Background We demonstrate our initial experience and first results of the endovascular aneurysm
sealing (EVAS) technology with chimney grafts for the treatment of paravisceral aneurysms.
Methods We present a consecutive series of seven patients with a mean age of 75 years who
had been treated by four-vessel-chimney EVAS (ChEVAS) between May 2014 and May 2015.
All patients were ASA grade ≥ III and were not eligible for fenestrated/branched endovascular
aortic repair (fEVAR/brEVAR) due to urgency (n = 5) or anatomical constraints (n = 2).
Results Total 28 renovisceral target vessels were treated by balloon-expandable covered stents
and 14 Nellix devices were used to seal the paravisceral aorta. Overall, 16 Nellix
(Endologix Inc., Irvine, California, United States) devices and 65 covered stents
were implanted with a technical success of 100%. Perioperatively, one patient with
ruptured aneurysm died due to respiratory failure following splenic laceration/splenectomy
(mortality = 14%) and in one patient, laceration of an axillary access vessel occurred.
At a median follow-up of 6 months, all six surviving patients were well and no reinterventions
were necessary. One chimney was found occluded without clinical sequelae resulting
in a patency rate of 96%.
Conclusion Four-vessel ChEVAS may serve as alternative treatment option in highly selected cases
of either acute paravisceral aortic pathology and/or situations, where the implantation
of fEVAR/brEVAR is hampered by anatomical constraints. Further follow-up and a multicenter
study are of course warranted to corroborate these initial results.
Keywords
aorta/aortic - stents - endovascular procedures/stents
