Aberdeen Vascular Surgical Service, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK.
Br J Surg. 2013 Nov;100(12):1557-64. doi: 10.1002/bjs.9274.
Conventional endovascular aneurysm repair (EVAR) needs a proximal aortic seal zone that is free from aortic branch vessels. The modified application of conventional EVAR devices using adjuvant chimney or periscope grafts is described as a pragmatic alternative to custom-made fenestrated and branched endografts. This systematic review examined the application and outcomes of chimney or periscope grafts for aortic aneurysm.
A search was performed for all studies of chimney or periscope grafts for EVAR. Clinical details and outcome in terms of technical success, survival, freedom from endoleak and branch vessel patency were examined.
Twenty-four studies describing 234 patients who underwent EVAR with one or more chimney or periscope grafts for aortic branch vessels were identified. Most procedures were elective; only 62 (26.5 per cent) were performed urgently. There were 176 patients with an abdominal aortic aneurysm and 58 with a thoracic or thoracoabdominal aortic aneurysm. Three hundred and seventy-six branch vessels were perfused. Twelve patients (5.1 per cent) died within 30 days of aneurysm repair. Twenty-seven patients (11.5 per cent) developed a type I endoleak. After a mean(s.d.) follow-up of 12(5) months, seven branch vessels stents had occluded.
These highly selected data support the potential value of chimney and periscope graft techniques for patients with challenging aortic aneurysm morphology. There is a lack of medium- and long-term follow-up data.
传统的血管内动脉瘤修复术（EVAR）需要一个近端主动脉密封区域，该区域没有主动脉分支血管。描述了传统 EVAR 器械的改良应用，即使用辅助烟囱或潜望镜移植物，作为定制的开窗和分支腔内移植物的实用替代方案。本系统评价检查了烟囱或潜望镜移植物在治疗主动脉瘤中的应用和结果。
对所有使用烟囱或潜望镜移植物进行 EVAR 的研究进行了搜索。检查了技术成功率、生存、无内漏和分支血管通畅的临床细节和结果。
确定了 24 项研究，共 234 例患者接受了 EVAR，其中 1 个或多个烟囱或潜望镜移植物用于主动脉分支血管。大多数手术是选择性的；只有 62 例（26.5%）是紧急进行的。有 176 例患者患有腹主动脉瘤，58 例患者患有胸主动脉瘤或胸腹主动脉瘤。376 个分支血管被灌注。12 例患者（5.1%）在动脉瘤修复后 30 天内死亡。27 例患者（11.5%）发生 I 型内漏。平均（标准差）随访 12（5）个月后，7 个分支血管支架闭塞。
这些高度选择的数据支持烟囱和潜望镜移植物技术在治疗具有挑战性的主动脉瘤形态方面的潜在价值。缺乏中、长期随访数据。
