Liu B, Pan H, Song X, Liu C, Wu W, Chen Y, Yang X
Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100032 Beijing, China.
Int Angiol. 2013 Jun;32(3):307-11.
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.
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.
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.
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.
本文旨在介绍我们在解剖结构不利的近肾主动脉瘤（JAA）的血管内动脉瘤修复术（EVAR）中使用烟囱式移植物的经验。
2001年1月至2011年1月期间，5例（4例男性和1例女性；平均年龄78岁）近肾主动脉瘤患者在肾动脉中采用烟囱式移植物进行治疗。所有病例均为开放修复高风险患者，且因颈部长度短或颈部角度大而不适用于标准的血管内腹主动脉瘤修复术。将6枚烟囱式支架（5枚球囊扩张式支架和1枚自膨式支架）植入肾动脉。
技术成功率为100%。最终血管造影显示效果极佳，肾脏血流良好，动脉瘤囊完全被隔绝，无I型内漏。平均随访期为15.8个月（范围1 - 52个月）。1例患者术后2个月因心力衰竭死亡。1例患者早期发现的小型II型内漏未经治疗在3个月内自行消失。随访期末所有烟囱式移植物均通畅。
烟囱式移植物技术是血管内主动脉修复术（EVAR）的扩展，特别适用于手术风险高的近肾主动脉瘤患者。即使在主动脉解剖结构不利的情况下，烟囱式移植物技术也是可行的。长期结果仍未知。
