Department of Vascular Surgery, St. Franziskus Hospital Münster, Münster, Germany; Second Department of Surgery, Division of Vascular Surgery, School of Medicine, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece.
Department of Vascular Surgery, St. Franziskus Hospital Münster, Münster, Germany.
J Vasc Surg. 2021 Feb;73(2):433-442. doi: 10.1016/j.jvs.2020.05.029. Epub 2020 May 27.
In the treatment of pararenal abdominal aortic aneurysms and aortic pathologic processes, chimney endovascular aneurysm repair (CHEVAR) represents an alternative technique for urgent cases. The aim of the study was to evaluate the outcomes of CHEVAR in the elective setting.
We performed a retrospective analysis of prospectively collected records of 165 consecutive asymptomatic CHEVAR patients who were treated between March 2009 and January 2018 with the Endurant stent graft (Medtronic, Santa Rosa, Calif). A total of 244 chimney grafts (CGs) were implanted. The primary end point was clinical success, defined as freedom from procedure-related mortality, persistent type IA endoleak, occlusion or high-grade stenosis (>70%) of CGs, and any chimney technique-related secondary procedure for the entire follow-up period. Secondary clinical success included patients with successful treatment of a primary end point with a secondary endovascular procedure.
All 244 targeted chimney vessels were successfully cannulated. Total perioperative morbidity was 7.8% (n = 13), including 3 (1.8%) cases of bowel ischemia, 1 (0.6%) patient with renal ischemia, and 1 patient (0.6%) with stroke. Median follow-up was 25.5 ± 2.2 months. Both 30-day and follow-up procedure-related mortality rates were 1.8% (n = 3). Primary and secondary freedom from persistent type IA endoleak rates were 96.4% (n = 159) and 99.4% (n = 164), respectively. Primary and secondary CG patency rates were 92.2% (n = 225) and 95.9% (n = 234), respectively. The rate of reinterventions related to the chimney technique was 10.9% (n = 18), and 83.3% of them were performed by endovascular means. The estimated cumulative primary patency and freedom from persistent type IA endoleak were 87.5% and 95.3%, respectively, and the primary and secondary clinical successes rates at midterm were 80.3% and 87.5%, respectively.
The elective use of CHEVAR with the Endurant stent graft in our series showed favorable midterm clinical results, which are similar to the published results of other total endovascular modalities. A prospective randomized trial of elective treatment of pararenal abdominal aortic aneurysms and aortic pathologic processes with current endovascular options is needed to assess the value of CHEVAR in the elective setting.
在治疗肾周腹主动脉瘤和主动脉病理过程中，烟囱腔内血管修复术（CHEVAR）是紧急情况下的另一种治疗方法。本研究的目的是评估择期 CHEVAR 的治疗结果。
我们对 2009 年 3 月至 2018 年 1 月期间，165 例无症状 CHEVAR 患者的前瞻性收集记录进行了回顾性分析，这些患者均采用 Endurant 支架移植物（美敦力，加利福尼亚州圣罗莎）治疗。共植入 244 个烟囱移植物（CG）。主要终点为临床成功，定义为无与手术相关的死亡率、持续性 1A 型内漏、CG 闭塞或重度狭窄（>70%）以及整个随访期间任何烟囱技术相关的二次手术。次要临床成功包括通过二次血管内手术成功治疗主要终点的患者。
所有 244 个目标烟囱血管均成功穿刺。总围手术期发病率为 7.8%（n=13），包括 3 例（1.8%）肠缺血、1 例（0.6%）肾缺血和 1 例（0.6%）中风。中位随访时间为 25.5±2.2 个月。30 天和随访期间的手术相关死亡率均为 1.8%（n=3）。持续性 1A 型内漏的主要和次要无复发率分别为 96.4%（n=159）和 99.4%（n=164）。CG 的主要和次要通畅率分别为 92.2%（n=225）和 95.9%（n=234）。与烟囱技术相关的再干预率为 10.9%（n=18），其中 83.3%通过血管内方式进行。累积的主要通畅率和无持续性 1A 型内漏的发生率分别为 87.5%和 95.3%，中期的主要和次要临床成功率分别为 80.3%和 87.5%。
在我们的研究中，使用 Endurant 支架移植物进行择期 CHEVAR 的治疗显示出良好的中期临床结果，与其他全血管内治疗方法的已发表结果相似。需要进行前瞻性随机试验，评估当前血管内治疗选择对肾周腹主动脉瘤和主动脉病理过程的择期治疗的价值，以评估 CHEVAR 在择期治疗中的价值。
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