1 Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy.
2 Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA.
J Endovasc Ther. 2018 Aug;25(4):492-498. doi: 10.1177/1526602818782941. Epub 2018 Jun 18.
The aim of this retrospective analysis was to evaluate the performance of the chimney (ch) technique in the treatment of type Ia endoleaks after standard endovascular aneurysm repair (EVAR).
Between January 2008 and December 2014, 517 chEVAR procedures were performed in 13 US and European vascular centers (PERICLES registry). Thirty-nine patients (mean age 76.9±7.1 years; 33 men) were treated for persistent type Ia endoleak and had computed tomography angiography or magnetic resonance angiography follow-up at >1 month. Endurant abdominal stent-grafts were used in the 20 cases. Single chimney graft placement was performed in 18 (46%) patients and multiple in 21 (54%). Overall, 70 visceral vessels were targeted for revascularization.
Technical success was achieved in 35 (89.7%) cases; 3 persistent type Ia endoleaks and 1 chimney graft occlusion were detected within the first 30 days. Thirty-day mortality was 2.6%. Two other deaths (not aneurysm related) occurred during a mean follow-up of 21.9 months (0.23-71.3). Primary patency of the chimney grafts was 94.3% at 36 months. In a subgroup analysis comparing Endurant to other stent-grafts, no significant differences were observed regarding persistent endoleak [1/20 (5%) vs 2/19 (11%), p=0.6] or reintervention [1/20 (5%) vs 0/19 (0%)].
The present series demonstrates that chEVAR in the treatment of post-EVAR type Ia endoleaks has satisfactory results independent of the abdominal and chimney graft combinations. Midterm results show that chEVAR is an effective method for treating type Ia endoleaks.
本回顾性分析旨在评估烟囱（ch）技术在治疗标准血管内动脉瘤修复（EVAR）后 I 型内漏中的应用效果。
2008 年 1 月至 2014 年 12 月，13 个美国和欧洲血管中心（PERICLES 注册）共进行了 517 例 chEVAR 手术。39 例（平均年龄 76.9±7.1 岁；33 例男性）因持续性 I 型内漏接受治疗，并在>1 个月时进行计算机断层扫描血管造影或磁共振血管造影随访。20 例使用 Endurant 腹主动脉支架移植物。18 例（46%）患者行单烟囱移植物置入，21 例（54%）患者行多烟囱移植物置入。共靶向 70 个内脏血管进行血运重建。
35 例（89.7%）患者达到技术成功；30 天内发现 3 例持续性 I 型内漏和 1 例烟囱移植物闭塞。30 天死亡率为 2.6%。另外 2 例死亡（与动脉瘤无关）发生在平均 21.9 个月（0.23-71.3）的随访期间。烟囱移植物的主要通畅率在 36 个月时为 94.3%。在比较 Endurant 与其他支架移植物的亚组分析中，持续性内漏[1/20（5%）与 2/19（11%），p=0.6]或再干预[1/20（5%）与 0/19（0%）]方面无显著差异。
本系列研究表明，在治疗 EVAR 后 I 型内漏方面，chEVAR 的结果令人满意，与腹部和烟囱移植物的组合无关。中期结果表明，chEVAR 是治疗 I 型内漏的有效方法。
