Technical aspects, current indications, and results of chimney grafts for juxtarenal aortic aneurysms Raphael Coscas, MD, Hicham Kobeiter, MD, Pascal.

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Presentation transcript:

Technical aspects, current indications, and results of chimney grafts for juxtarenal aortic aneurysms Raphael Coscas, MD, Hicham Kobeiter, MD, Pascal Desgranges, MD, PhD, Jean-Pierre Becquemin, MD Journal of Vascular Surgery Volume 53, Issue 6, Pages 1520-1527 (June 2011) DOI: 10.1016/j.jvs.2011.01.067 Copyright © 2011 Terms and Conditions

Fig 1 The proximal “kissing balloon” technique used after deployment of a chimney graft (CG) is shown. In this patient, a persistent type Ia endoleak was noted on the lateral side of the proximal neck on completion angiography after a CG incorporating the two renal arteries. A compliant balloon was inflated in the aorta at the level of the left renal stent, which was preserved by the concurrent inflation of a noncompliant balloon in the lumen (black arrows). The right renal stent had been implanted slightly higher than the left one and ballooning was not necessary at this level (white arrow). This maneuver was successful, and the endoleak disappeared. Journal of Vascular Surgery 2011 53, 1520-1527DOI: (10.1016/j.jvs.2011.01.067) Copyright © 2011 Terms and Conditions

Fig 2 A patient presented with a descending thoracic aneurysm and a 57-mm juxtarenal aneurysm, with contraindications to open surgery. A thoracic stent graft was successfully implanted during a first procedure (A), but introduction of the device through the left iliac axis caused a dissection at this level, rescued by a femorofemoral crossover bypass. Due to the left iliac thrombosis, a chimney graft (CG) associating an aorto-uni-iliac endograft with stents in the renal arteries and the superior mesenteric artery (SMA) was implanted to treat the juxtarenal aortic aneurysm (JAA) with a good result (B-D). Eleven months later, the two aneurysms remained excluded and stable in diameter. Journal of Vascular Surgery 2011 53, 1520-1527DOI: (10.1016/j.jvs.2011.01.067) Copyright © 2011 Terms and Conditions

Fig 3 Treatment algorithm of juxtarenal aortic aneurysms ≥55 mm in our department is shown. CG, Chimney graft; FBE, fenestrated/branched endograft. Journal of Vascular Surgery 2011 53, 1520-1527DOI: (10.1016/j.jvs.2011.01.067) Copyright © 2011 Terms and Conditions

Fig 4 In contrast to the scheme described by Ohrlander et al11, the stents of a chimney graft (CG) do not necessarily take a perpendicular path alongside the endograft to enter the renal arteries. Actually, we observed that the stents positioned themselves in a more oblique and helical direction, as illustrated by these (A) anterior-lateral and (B) posterior views of a two-vessel CG. In the present case, self-expandable stents (arrows) were deployed into the covered stents to improve the stability and the long-term patency of the repair. Journal of Vascular Surgery 2011 53, 1520-1527DOI: (10.1016/j.jvs.2011.01.067) Copyright © 2011 Terms and Conditions