Mario Lachat1, Felice Pecoraro2, Thomas Pfammatter1, Thomas Frauenfelder1, Michael Glenck1, Dominique Bettex1, Dieter Mayer1, Zoran Rancic1, Frank J. Veith3
1Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; 2University of Palermo, Palermo, Italy; 3New York University Medical Center, New York, NY.
OBJECTIVES: Chimney and periscope grafts (CP) allow maintaining patency of aortic branches when their orifices require coverage by aortic stent grafts. We present a series of 77 patients in which CP have been used to treat complex thoracic and/or abdominal aneurysms or to simplify hybrid procedures.
METHODS: We analyzed retrospectively 77 consecutive patients treated from February 2002 to December 2011. Aneurysms involved the visceral aortic segment (67), the aortic arch (10) or both (1). Sixty-one patients were treated with CP and EVAR (CP-EVAR) in a one stage procedure and 16 patients (21%) were treated sequentially by a hybrid approach in which partial surgical debranching was followed by CP-EVAR. Thirteen patients (17%) were treated for an aortic rupture. Viabahn© or Hemobahn© stent grafts were used as CP.
RESULTS: One-hundred sixty CP were used to revascularize 11 aortic arch branches and 149 renovisceral branches. Technical success of CP was 99.4% (159/160). 30-day mortality was 7% (5/77) and 15% (2/13) for the ruptured cases. During a mean follow-up of 11.83 months (range 1-100 months), all but three CP remained patent. Endoleaks (ELs), mainly type II, were observed in 33%. Six patients (8%) with attachment ELs (Ia or Ib) underwent successful secondary sealing procedures. Mean aortic diameter decreased by 12.73% (mean: 5.9; SD: 11.76). Thirteen patients followed with CTA >12 months (range 14-100 months) had stable reconstructions without ELs or aneurysm enlargement.
CONCLUSIONS: Chimney and periscope grafts are a safe and effective way to facilitate EVAR or hybrid procedures for complex aortic aneurysms. Moreover, these techniques, using only off-the-shelf endograft components, are useful to treat ruptured aneurysms involving vital aortic branches. Mid-term results (up to 8 years) are promising. However, long-term durability needs to be confirmed.
AUTHOR DISCLOSURES: D. Bettex, Nothing to disclose; T. Frauenfelder, Nothing to disclose; M. Glenck, Nothing to disclose; M. Lachat, Nothing to disclose; D. Mayer, Nothing to disclose; F. Pecoraro, Nothing to disclose; T. Pfammatter, Nothing to disclose; Z. Rancic, Nothing to disclose; F. J. Veith, Nothing to disclose.
Posted April 2012