Chimney Stent Grafts Proving Successful in Treating Complex Aortic Aneurysms
October 16, 2013 – Midterm results are showing a high success rate for patients with complex aortic aneurysms treated using the chimney stent-graft technique and its periscope variation. Open graft repair can be risky for patients with pararenal or thoracoabdominal aneurysms. This alternative technique offers emergency treatment and another option for patients unsuitable for open surgery or branched/fenestrated stent-grafts.
The current issue of the Journal of Endovascular Therapy reports success rates of 111 chimney and 58 periscope grafts in 77 patients. These procedures were performed over a 10-year period, and follow-up examinations were conducted at 6 weeks; 3, 6, and 12 months; then annually. Most patients — 95 percent — showed decreased or stable aneurysm size. The mean length of follow-up among these patients is more than 2 years, providing a midterm look at the effectiveness of this procedure. The results show an average aneurysm diameter reduction of 13 percent. While 20 patients had endoleaks at discharge following the procedure, only 3 patients continued to have leaks at the time of follow-up.
The chimney graft technique preserves blood flow to side branches of the aorta by deploying a stent or covered stent parallel to the main aortic stent-graft. It extends upwards, like a chimney, while the periscope variation of this technique is downward facing. The chimney graft method uses commercially available stent devices rather than custom-made branched ones — allowing immediate use in emergency situations.
An accompanying commentary emphasizes that the length of the chimney grafts can present a challenge and that meticulous attention to detail is key to the success of this technique. However, the chimney grafts are proving to last over time, allaying initial concerns of deterioration and type III leaks. The authors declare that the results so far prove the technique to be safe and effective and justify its wider use.
Full text of the article, “Chimney and Periscope Grafts Observed Over 2 Years After Their Use to Revascularize 169 Renovisceral Branches in 77 Patients With Complex Aortic Aneurysms” and commentary article, Journal of Endovascular Therapy, Vol. 20, No. 5, 2013, are now available.