Chimney stents for endovascular repair of juxtarenal aortic aneurysms with unfavourable anatomy

Abstract

Aim: The aim of this paper was to present our experience with the use of chimney grafts in endovascular aneurysm repair (EVAR) of juxtarenal aortic aneurysms (JAA) with unfavourable anatomy.

Methods: Between January 2001 and January 2011, 5 patients (4 men and 1 woman; mean age 78 years) with JAAs were treated with chimney grafts in the renal arteries. All the cases were at high risk for open repair and were unsuitable for standard endovascular abdominal aortic aneurysm repair because of short neck length, or large neck angulation. Six chimney stents (5 balloon expandable stents and 1 self-expandable stent) were implanted into the renal arteries.

Results: The technical success was 100%. The final angiography showed excellent results, with good flow into the kidneys and complete exclusion of the aneurysm sac and no type I endoleaks. The average follow-up period was 15.8 months (range, 1-52 months). One patient died two months after surgery because of heart failure. An early small type II endoleak found in one patient resolved within three months without treatment. All chimney grafts were patent at the end of the follow-up period.

Conclusion: The chimney graft technique is an expansion of endovascular aortic repair (EVAR), especially suitable for juxtarenal aortic aneurysms in patients with a high surgical risk. The chimney graft technique is feasible, even in the setting of unfavourable aortic anatomy. Long-term results are still unknown.