TY  - BOOK
AU  - Criado, Frank J
TI  - Results of chimney endovascular aneurysm repair as used in the PERICLES Registry to treat patients with suprarenal aortic pathologies
SN  - 0741-5214
PY  - 2020///
KW  - *Aortic Diseases/su [Surgery]
KW  - *Blood Vessel Prosthesis Implantation
KW  - *Endovascular Procedures
KW  - *Mesenteric Artery, Superior/su [Surgery]
KW  - *Renal Artery/su [Surgery]
KW  - Aged
KW  - Aged, 80 and over
KW  - Aortic Diseases/dg [Diagnostic Imaging]
KW  - Aortic Diseases/pp [Physiopathology]
KW  - Blood Vessel Prosthesis
KW  - Blood Vessel Prosthesis Implantation/ae [Adverse Effects]
KW  - Blood Vessel Prosthesis Implantation/is [Instrumentation]
KW  - Endovascular Procedures/ae [Adverse Effects]
KW  - Endovascular Procedures/is [Instrumentation]
KW  - Europe
KW  - Female
KW  - Humans
KW  - Male
KW  - Mesenteric Artery, Superior/dg [Diagnostic Imaging]
KW  - Mesenteric Artery, Superior/pp [Physiopathology]
KW  - Postoperative Complications/et [Etiology]
KW  - Prosthesis Design
KW  - Registries
KW  - Renal Artery/dg [Diagnostic Imaging]
KW  - Renal Artery/pp [Physiopathology]
KW  - Retrospective Studies
KW  - Risk Factors
KW  - Stents
KW  - Time Factors
KW  - Treatment Outcome
KW  - United States
KW  - MedStar Union Memorial Hospital
KW  - Vascular Surgery
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - BACKGROUND: The prevailing evidence calls for using chimney/snorkel endovascular repair (ch-EVAR) with one or two chimney grafts. No studies up to now focus on its applicability and results for the treatment of suprarenal aortic pathologies (SRAP). Hence, we evaluated the clinical and radiologic results of ch-EVAR treatment for SRAP placing three or more chimney grafts within the PERICLES Registry; CONCLUSIONS: The midterm use of ch-EVAR for the treatment SRAP seems to be safe, highlighting its applicability for the treatment of rupture threatening pathologies and seal zone lengthening as in type IA endoleaks after EVAR. However, the incidence of type IA endoleaks, chimney graft occlusions, and ischemic stroke rates is higher compared with the prevailing single chimney evidence. Longer follow-up with more cases is needed to establish the exact performance of this treatment in SRAP. Copyright (c) 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved; METHODS: Data from 517 patients suffering complex aortic pathologies treated by ch-EVAR between 2008 and 2014 at 13 European and U.S. centers were retrospectively reviewed and analyzed; RESULTS: Sixty-seven ch-EVAR-treated patients (12.9% of the entire PERICLES cohort) presented SRAP (83.5% elective, 16.5% urgent). The majority of patients (95.5%) received three chimney grafts; four patients received four chimney grafts. The Endurant device was the most commonly used (35.8%) followed by the Zenith abdominal endograft (19.4%). Overall, 204 chimney grafts were placed (56.7% covered self-expandable, 40.3% covered balloon-expandable stents, and 10.4% bare metal balloon-expandable stents). At a median follow-up of 24 months (range, 0.1-67.0 days), 30-day mortality was 6.1% (4 patients), and the overall mortality was 16.4% (11 patients). Overall survival was 87.4% (range, 79.5%-96.0%) at 1 year, 81.8% (range, 72.2%-92.2%) at 2 years and thereafter. Type IA endoleak was noted in nine patients (13.4%) intraoperatively and successfully treated in seven cases (97.1% technical success). Aneurysm sac diameter significantly decreased from 70.5 +/- 19.3 mm to 66.9 +/- 20.6 mm (P < .001) at last follow-up. Ischemic stroke or transient ischemic attack were noted in two patients (2.9%). Chimney occlusion was detected in six renal arteries (9.5%) and two superior mesenteric arteries (3.2%). No patients required chronic hemodialysis. All occluded superior mesenteric artery grafts were successfully rescued using endovascular approaches
UR  - https://dx.doi.org/10.1016/j.jvs.2019.08.228
ER  -