Department of Vascular Surgery, St. Franziskus Hospital Münster, and Center for Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany.
J Endovasc Ther. 2010 Oct;17(5):589-93. doi: 10.1583/10-3083.1.
To present our initial experience with the use of chimney grafts in endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) with challenging anatomy.
Among 390 EVAR cases performed at our institution between November 2008 and February 2010, 15 patients (all men; mean age 81.8 years) underwent EVAR with synchronous placement of chimney grafts. The chimney technique involved placing covered stents parallel to the main aortic stent-graft to preserve or rescue flow to aortic branch vessels while extending the proximal fixation zone. All patients presented with pararenal aortic aneurysms with short necks (between 0 and 10 mm long) that required either suprarenal clamping to tailor a proximal anastomosis in open repair or suprarenal fixation to anchor an endoprosthesis. Chimney grafts were implanted into 10 left renal and 5 right renal arteries.
The immediate technical success was 100%. One early type II endoleak due to retrograde flow from the inferior mesenteric artery was detected and is under surveillance. Mean follow-up was 6.8 months (range 1-13). One chimney graft occluded 45 days postoperatively; the patient underwent open thrombectomy of the left renal artery and iliorenal bypass. The creatinine value at discharge was 1.6 mg/dL, and resting renal scintigraphy showed 36% perfusion for the left kidney and 64% for the right kidney. During follow-up, no patient required hemodialysis; no aneurysm-related deaths were noted.
This limited experience demonstrates that the use of abdominal chimney grafts is feasible and safe. Long-term results in larger patient cohorts are needed evaluate the utility of this alternative endovascular technique.
介绍我们在血管内动脉瘤修复术（EVAR）中使用烟囱移植物治疗具有挑战性解剖结构的腹主动脉瘤（AAA）的初步经验。
在我们机构 2008 年 11 月至 2010 年 2 月期间进行的 390 例 EVAR 病例中，有 15 例患者（均为男性；平均年龄 81.8 岁）接受了 EVAR 治疗，并同时放置了烟囱移植物。烟囱技术涉及平行放置带覆盖支架的支架，以在保持或恢复向主动脉分支血管的血流的同时，扩大近端固定区。所有患者均患有肾周型主动脉瘤，瘤颈较短（0-10mm 长），需要在开放修复中夹闭肾上极来定制近端吻合口，或在肾上极固定来锚定内假体。烟囱移植物被植入 10 个左肾动脉和 5 个右肾动脉。
即刻技术成功率为 100%。1 例早期 II 型内漏是由于肠系膜下动脉逆行血流引起的，正在监测中。平均随访时间为 6.8 个月（1-13 个月）。1 例烟囱移植物在术后 45 天闭塞；患者接受了左肾动脉开放血栓切除术和肾-髂旁路术。出院时的肌酐值为 1.6mg/dL，静息肾闪烁扫描显示左肾灌注为 36%，右肾灌注为 64%。随访期间，无患者需要血液透析；未发生与动脉瘤相关的死亡。
这一有限的经验表明，使用腹部烟囱移植物是可行和安全的。需要在更大的患者队列中进行长期结果评估，以评估这种替代血管内技术的效用。
