Department of Vascular Surgery, St. Franziskus Hospital Münster and the Clinic for Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany.
J Vasc Surg. 2012 Mar;55(3):659-65. doi: 10.1016/j.jvs.2011.09.052. Epub 2011 Dec 9.
To present the clinical experience of consecutive series with use of balloon-expandable and self-expanding chimney endografts (balloon-expandable covered stent group [BECS] vs self-expanding covered stent group [SECS]) in the endovascular treatment of challenging aortic pathologies requiring renal and/or visceral revascularization.
Between January 2009 and May 2011, data for 37 high-risk patients from one center and 35 patients from another institution, with pararenal aortic pathologies treated by the chimney endovascular technique, were prospectively collected. The chimney-graft technique is based on the deployment of a covered or bare-metal stent parallel to the aortic endograft, thereby creating a conduit that runs outside the aortic main endograft, and has been proposed to ensure secure proximal fixation extending the sealing zones.
Forty-six consecutive target vessels (43 renal arteries and 3 superior mesenteric arteries) were revascularized by the Advanta (Atrium, Hudson, NH) BECS (1.2 chimneys/patient); in contrast, 81 consecutive target vessels (64 renal arteries, 11 superior mesenteric arteries, and 6 celiac trunks) were revascularized by the Viabahn (Gore, Flagstaff, Ariz) SECS (2.3 chimneys/patient). The success rate for target vessel preservation was 97.8% for the BECS group and 100% for the SECS group in the entire follow up. There was one symptomatic left renal artery occlusion of the BECS group treated by open thrombectomy of the left renal artery and placement of 8-mm Dacron (BBraun, Aesculap AG, Tuttlingen, Germany) iliorenal bypass. Additionally, one patient underwent repeat balloon angioplasty with a 5-mm balloon due to high-grade in-stent stenosis of a 6 × 59 Advanta stent graft 12 months postoperatively. Overall, one perioperative (and not present in the computed tomography angiography at discharge) type Ia endoleak was detected in the BECS group. In contrast, five perioperative type Ia endoleaks were present in the SECS group; however, only one of them was persistent in the radiological imaging and was treated by proximal extension of a 5-mm cuff, 1 year postoperatively, due to continuous aneurismal sac increase. No patient of any subgroup developed postoperative persistent renal insufficiency with need of hemodialysis. Thirty-day and during the follow-up procedure-related mortality was 0% for both BECS and SECS groups.
In summary, midterm results of use of covered chimney stents for pararenal aortic pathologies show safety and feasibility with excellent patency and low incidence of endoleaks.
介绍连续系列使用球囊扩张和自膨式烟囱内支架（球囊扩张覆膜支架组 [BECS] 与自膨式覆膜支架组 [SECS]）在需要肾和/或内脏血运重建的挑战性主动脉病变的血管内治疗中的临床经验。
2009 年 1 月至 2011 年 5 月，从一家中心前瞻性收集了 37 名高危患者和另一家机构的 35 名患者的数据，这些患者均患有肾周主动脉病变，采用烟囱腔内技术治疗。烟囱移植物技术是基于将覆盖或裸金属支架平行部署到主动脉内移植物上，从而创建一个在主动脉主移植物外部运行的导管，并已提出确保近端固定的安全，扩大密封区。
46 个连续靶血管（43 个肾动脉和 3 个肠系膜上动脉）通过 Advanta（Atrium，Hudson，NH）BECS（每个患者 1.2 个烟囱）进行血运重建；相比之下，81 个连续靶血管（64 个肾动脉，11 个肠系膜上动脉和 6 个腹腔干）通过 Viabahn（戈尔，Flagstaff，Ariz）SECS（每个患者 2.3 个烟囱）进行血运重建。BECS 组靶血管保存成功率为 97.8%，SECS 组在整个随访期间为 100%。BECS 组有 1 例症状性左肾动脉闭塞，行左肾动脉开放血栓切除术和放置 8mm Dacron（BBraun，Aesculap AG，Tuttlingen，德国）髂肾旁路。此外，1 例患者因术后 12 个月 Advanta 支架移植物 6×59 支架内重度狭窄，行 5mm 球囊再次球囊血管成形术。总体而言，BECS 组有 1 例围手术期（出院时计算机断层血管造影术未发现）Ia 型内漏。相比之下，SECS 组有 5 例围手术期 Ia 型内漏，但只有 1 例持续存在，由于连续的动脉瘤囊增大，在术后 1 年通过近端延伸 5mm 袖口进行治疗。任何亚组的患者均未出现术后持续性肾功能不全，需要血液透析。BECS 和 SECS 组的 30 天和随访期间的手术相关死亡率均为 0%。
总之，使用覆膜烟囱支架治疗肾周主动脉病变的中期结果显示出安全性和可行性，通畅率高，内漏发生率低。
