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Outcome of visceral chimney grafts after urgent endovascular repair of complex aortic lesions  Adel Bin Jabr, MD, PhD, Bengt Lindblad, MD, PhD, Thorarinn.

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Presentation on theme: "Outcome of visceral chimney grafts after urgent endovascular repair of complex aortic lesions  Adel Bin Jabr, MD, PhD, Bengt Lindblad, MD, PhD, Thorarinn."— Presentation transcript:

1 Outcome of visceral chimney grafts after urgent endovascular repair of complex aortic lesions 
Adel Bin Jabr, MD, PhD, Bengt Lindblad, MD, PhD, Thorarinn Kristmundsson, MD, PhD, Nuno Dias, MD, PhD, Timothy Resch, MD, PhD, Martin Malina, MD, PhD  Journal of Vascular Surgery  Volume 63, Issue 3, Pages (March 2016) DOI: /j.jvs Copyright © 2016 Society for Vascular Surgery Terms and Conditions

2 Fig 1 A chimney graft (CG) was implanted for extension of a previously failed endovascular aneurysm repair (EVAR) because of type I endoleak (EL-I). The arrowhead shows the proximal end of the failed graft's fabric; the arrow shows where the second stent graft (SG) is being deployed. A left renal CG is inserted and ready to be deployed. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Kaplan-Meier outcome function curves for 51 patients who underwent endovascular aneurysm repair (EVAR) with visceral chimney grafts (CGs). The outcome curves demonstrate the freedom from chimney-related mortality (A), type I endoleak (EL-I; B), aortic lesion-related mortality (C), and all-cause mortality (D). The vertical dotted line indicates the time when the standard error (SE) equals 10% (at 82 months). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

4 Fig 3 Kaplan-Meier outcome analysis for 73 visceral chimney grafts (CGs) in 51 patients with endovascular aneurysm repair (EVAR). The function curves demonstrate the primary CG patency (G), assisted primary CG patency (F), and secondary CG patency (E). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

5 Fig 4 A 74-year-old woman presented with a large ruptured complex suprarenal abdominal aortic aneurysm (AAA; A and B) that was treated with endovascular aneurysm repair (EVAR) and chimney grafts (CGs) to the superior mesenteric artery (SMA) and left renal artery (C and D). The right kidney was sacrificed. A retroperitoneal hematoma due to a suspected proximal type I endoleak (EL-I) was followed up for 7 months until the general condition of the patient deteriorated with increasing signs of ongoing intra-abdominal infection. Then, computed tomography angiography (CTA; C) showed a proximal EL-I (yellow interrupted lines), which was confirmed at angiography (D). The endoleak could be cannulated from a brachial approach through the SMA chimney, the pancreaticoduodenal artery, retrograde to the gastroduodenal artery, and through the celiac trunk (red dotted line) to the parachimney gutter of the left renal CG. The nidus was embolized with Onyx (E). Finally, the chimney gutters were embolized (F). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

6 Fig 5 Patient with ruptured abdominal aortic aneurysm (AAA) who was treated urgently with endovascular aneurysm repair (EVAR) and chimney grafts (CGs) to both renal arteries. Postoperative computed tomography angiography (CTA) demonstrated partial coverage of the superior mesenteric artery (SMA) orifice by the left renal CG (A and B; arrows). Perfusion of the SMA (arrowheads) was secured by insertion of another CG into the SMA (C). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

7 Fig 6 A, Juxtarenal ruptured abdominal aortic aneurysm (AAA) that was treated with a right renal chimney graft (CG) without sacrificing any artery (B), resulting in intraoperative proximal type I endoleak (EL-I) that was spontaneously sealed within 4 months but recurred 14 months after the index operation (arrow). The endoleak was resolved (C) by placing a Palmaz stent and embolizing the gutters with Onyx. The patient is in the fifth year after reintervention without recurrence. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

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