ChEVAR technique for emergent aneurysm repair - a retrospective case series
DOI:
https://doi.org/10.48750/acv.578Palavras-chave:
Aortic Aneurysm, Abdominal, Aneurysm, Ruptured, Endovascular Aneurysm Repair, Chimney, Parallel stentsResumo
INTRODUCTION: Chimney EVAR (ChEVAR) for the treatment of complex abdominal aortic aneurysm (AAA) has been largely relegated for when fenestrated endografts are unavailable, especially due to durability concerns. However, the off-the-shelf nature of ChEVAR makes it a good option for emergent AAA repair. We report our institutional experience in ChEVAR in an urgent setting.
METHODS: ChEVAR procedures were collected from 2019 to 2023 in a tertiary hospital, and a retrospective analysis was performed. This includes gathered information from electronic medical records, surgical reports and the picture archiving system. Descriptive statistics were applied. The main endpoints were technical success, 30-day and 1-year survival.
RESULTS: Five patients were submitted to urgent aneurysm repair using the chEVAR technique. Average age was 73,4 years and all patients were male. Arterial hypertension was present in 100% patients and all patients were ASA 4. Indications for surgery were post EVAR type 1a endoleak with associated rupture or abdominal pain in two patients; symptomatic/contained rupture of pararenal AAA in two patients; and contained rupture of a thoracoabdominal aneurysm in one patient. A total of eight target vessels were catheterized: two patients required single-vessel chimney and the remainder two-vessel chimney. Target vessels were two superior mesenteric arteries and six renal arteries. Technical success rate was 100% and 30-day mortality was 0%. There were no major complications. Follow-up time is 20.2 months (4.7-38). Target vessel patency during the follow-up period was 87.5%. Three patients (60%) died due to non-aortic related pathologies, on average 18 months after surgery (4.7-38), with a 1-year survival of 80%.
CONCLUSION: Our experience with ChEVAR for emergent AAA repair is satisfactory, with high technical success rates and low short-term mortality. Sac regression, low rates of target vessel occlusion and type 1a endoleaks reveal a favourable profile for aneurysm exclusion. ChEVAR is a viable option in emergent setting for patients unfit for open repair.
Downloads
Referências
Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc 2019;57:8–93.
Greenberg RK, Clair D, Srivastava S, Bhandari G, Turc A, Hampton J, et al. Should patients with challenging anatomy be offered endovascular aneurysm repair? J Vasc Surg 2003;38:990–6.
Donas KP, Lee JT, Lachat M. Collected World Experience About the Performance of the Snorkel/Chimney Endovascular Technique in the Treatment of Complex Aortic Pathologies: The PERICLES Registry. J Vasc Surg 2015;62:1677.
Taneva GT, Lee JT, Tran K, Dalman R, Torsello G, Fazzini S, et al. Long-term chimney/snorkel endovascular aortic aneurysm repair experience for complex abdominal aortic pathologies within the PERICLES registry. J Vasc Surg 2021;73:1942-9.
Prapassaro T, Teraa M, Chinsakchai K, Hazenberg CEVB, Hunnangkul S, Moll FL, et al. Mid-Term Outcomes of Chimney Endovascular Aortic Aneurysm Repair: A Systematic Review and Meta-analysis. Ann Vasc Surg 2022;79:359–71.
Zlatanovic P, Jovanovic A, Tripodi P, Davidovic L. Chimney vs. Fenestrated Endovascular vs. Open Repair for Juxta/Pararenal Abdominal Aortic Aneurysms: Systematic Review and Network Meta-Analysis of the Medium-Term Results. J Clin Med 2022;11:6779
Gallitto E, Faggioli G, Logiacco A, Mascoli C, Spath P, Palermo S, et al. Anatomical feasibility of the current endovascular solutions for Juxtarenal aortic abdominal aneurysm repair. Vascular 2023;31:833-40
Spath P, Tsilimparis N, Furlan F, Hamwi T, Prendes CF, Stana J. Additional Aortic Coverage With Off The Shelf, Multibranched Endograft Compared With Custom-Made Devices For Endovascular Repair of Pararenal Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2023;65:710-8.
