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Lovell J, Lovelock T, Slater J, Thoo C. Chimney endovascular aortic repair is a viable salvage technique in a paravisceral pseudoaneurysm secondary to acute on chronic pancreatitis. Vascular 2023; 31:1076-1081. [PMID: 35738841 DOI: 10.1177/17085381221111012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pseudoaneurysms of the abdominal aorta secondary to pancreatitis are an extremely rare clinical entity, however, can result in life threatening complications. OBJECTIVE To describe a chimney endovascular aneurysm repair (Ch-EVAR) for an acute pancreatitis related paravisceral aortic pseudoaneurym. METHOD Prospective data collected from subject. RESULTS We present a case of 23-year-old female who underwent a successful salvage Ch-EVAR for a ruptured paravisceral pseudoaneurysm secondary to acute on chronic pancreatitis. CONCLUSION Ch-EVAR may present a viable temporizing or definitive therapeutic treatment option for a paravisceral pseudoaneurysm, particularly in the setting of acute pancreatitis. Further studies are warranted to elucidate the long term viability of Ch-EVAR grafts in the suprarenal, paravisceral aortic position.
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Affiliation(s)
- Janaka Lovell
- Department of Vascular Surgery, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Thomas Lovelock
- Department of Vascular Surgery, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Jacqueline Slater
- Department of General Surgery, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Catherine Thoo
- Department of Vascular Surgery, Royal Hobart Hospital, Hobart, TAS, Australia
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Marquis KM, Naeem M, Rajput MZ, Raptis DA, Steinbrecher KL, Ohman JW, Bhalla S, Raptis CA. CT of Postoperative Repair of the Ascending Aorta and Aortic Arch. Radiographics 2021; 41:1300-1320. [PMID: 34415808 DOI: 10.1148/rg.2021210026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
While many of the classic open surgical repairs are still used to repair the ascending aorta, management of the aortic arch has become more complex via implementation of newer open surgical and endovascular techniques. Furthermore, techniques are often combined in novel repairs or to allow extended anatomic coverage. As such, a framework that rests on understanding the expected postoperative appearance is necessary for the diagnostic radiologist to best interpret CT studies in these patients. After reviewing the imaging appearances of the common components used in proximal aortic repair, the authors present a structured approach that focuses on the key relevant questions that diagnostic radiologists should consider when interpreting CT studies in these patients. For repair of the ascending aorta, this includes determining whether the aortic valve has been repaired, whether the sinuses of Valsalva have been repaired, and how the coronary arteries were managed, when necessary. In repairs that involve the aortic arch, the relevant considerations relate to management of the arch vessels and the distal extent of the repair. In focusing on these questions, the diagnostic radiologist will be able to identify and describe the vast majority of repairs. Understanding these questions will also facilitate improved understanding of novel repairs, which often use these basic building blocks. Finally, complications-which typically involve infection, noninfectious repair breakdown, hemorrhage, problems with endografts, or disease of the remaining adjacent aorta-will be identifiable as deviations from the expected postoperative appearance. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Kaitlin M Marquis
- From the Mallinckrodt Institute of Radiology (K.M.M., M.N., M.Z.R., D.A.R., K.L.S., S.B., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Muhammad Naeem
- From the Mallinckrodt Institute of Radiology (K.M.M., M.N., M.Z.R., D.A.R., K.L.S., S.B., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Mohamed Zak Rajput
- From the Mallinckrodt Institute of Radiology (K.M.M., M.N., M.Z.R., D.A.R., K.L.S., S.B., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Demetrios A Raptis
- From the Mallinckrodt Institute of Radiology (K.M.M., M.N., M.Z.R., D.A.R., K.L.S., S.B., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Kacie L Steinbrecher
- From the Mallinckrodt Institute of Radiology (K.M.M., M.N., M.Z.R., D.A.R., K.L.S., S.B., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - J Westley Ohman
- From the Mallinckrodt Institute of Radiology (K.M.M., M.N., M.Z.R., D.A.R., K.L.S., S.B., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology (K.M.M., M.N., M.Z.R., D.A.R., K.L.S., S.B., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Constantine A Raptis
- From the Mallinckrodt Institute of Radiology (K.M.M., M.N., M.Z.R., D.A.R., K.L.S., S.B., C.A.R.) and Department of Surgery (J.W.O.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
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Full realization of internal mammary artery injury after blunt chest trauma. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:504-510. [PMID: 32082790 DOI: 10.5606/tgkdc.dergisi.2018.15302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/31/2018] [Indexed: 11/21/2022]
Abstract
Due to the substantial and continual increase in the number of motorized vehicles globally, clinicians are faced with an enormous population at risk for suffering internal mammary artery injuries after blunt chest trauma. Nevertheless, very little attention has been paid to this issue by relevant health practitioners. In addition, there is a scarcity of extant research data, as well as societal guidelines, regarding internal mammary artery injury. In cases with undetected internal mammary artery injury, however, the outcome may be catastrophic or fatal. Thus, investigating and reviewing the anatomy, etiology, diagnostic approaches, and treatment strategies for patients with internal mammary artery injury are urgently needed.
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Paik JH, Jung HM, Yun SH, Lee JS, Han SB, Kim JS, Kim JH. Spontaneous Rupture of Abdominal Aorta after Seizure in a 23-Year-Old Woman: A Case Report. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791402100201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Spontaneous non-aneurysmal aortic rupture is a rare and life threatening clinical entity. A 23-year-old female patient who visited a nearby hospital due to intractable seizure was transferred to our hospital with the impression of hypotension and decreased level of haemoglobin. She had a history of seizure attacks once a month. However, in the 2 weeks before presentation, the frequency of seizure attacks had increased to 2 to 3 times a day. An abdominal-pelvic computed tomogram scan showed extravasation of contrast from the abdominal aorta at L3 level. An emergency laparotomy revealed a 0.3 cm diameter tear in the posterior wall of the aorta, superior to the iliac bifurcation. We discuss the mechanism of spontaneous aortic rupture and the possibility of aortic rupture related to seizure attacks. (Hong Kong j.emerg.med. 2014;21:103-106)
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Tricarico R, He Y, Laquian L, Scali ST, Tran-Son-Tay R, Beck AW, Berceli SA. Hemodynamic and Anatomic Predictors of Renovisceral Stent-Graft Occlusion Following Chimney Endovascular Repair of Juxtarenal Aortic Aneurysms. J Endovasc Ther 2017; 24:880-888. [PMID: 28914135 DOI: 10.1177/1526602817731096] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify anatomic and hemodynamic changes associated with impending visceral chimney stent-graft occlusion after endovascular aneurysm repair (EVAR) with the chimney technique (chEVAR). METHODS A retrospective evaluation was performed of computed tomography scans from 41 patients who underwent juxtarenal chEVAR from 2008 to 2012 to identify stent-grafts demonstrating conformational changes following initial placement. Six subjects (mean age 74 years; 3 men) were selected for detailed reconstruction and computational hemodynamic analysis; 4 had at least 1 occluded chimney stent-graft. This subset of repairs was systematically analyzed to define the anatomic and hemodynamic impact of these changes and identify signature patterns associated with impending renovisceral stent-graft occlusion. Spatial and temporal analyses of cross-sectional area, centerline angle, intraluminal pressure, and wall shear stress (WSS) were performed within the superior mesenteric and renal artery chimney grafts used for repair. RESULTS Conformational changes in the chimney stent-grafts and associated perturbations, in both local WSS and pressure, were responsible for the 5 occlusions in the 13 stented branches. Anatomic and hemodynamic signatures leading to occlusion were identified within 1 month postoperatively, with a lumen area <14 mm2 (p=0.04), systolic pressure gradient >25 Pa/mm (p=0.03), and systolic WSS >45 Pa (p=0.03) associated with future chimney stent-graft occlusion. CONCLUSION Chimney stent-grafts at increased risk for occlusion demonstrated anatomic and hemodynamic signatures within 1 month of juxtarenal chEVAR. Analysis of these parameters in the early postoperative period may be useful for identifying and remediating these high-risk stent-grafts.
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Affiliation(s)
- Rosamaria Tricarico
- 1 Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Yong He
- 2 North Florida/South Georgia Veterans Health System, University of Florida, Gainesville, FL, USA.,3 Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Liza Laquian
- 3 Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Salvatore T Scali
- 2 North Florida/South Georgia Veterans Health System, University of Florida, Gainesville, FL, USA.,3 Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Roger Tran-Son-Tay
- 1 Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.,4 Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA
| | - Adam W Beck
- 5 University of Alabama School of Medicine, Birmingham, AL, USA
| | - Scott A Berceli
- 1 Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA.,2 North Florida/South Georgia Veterans Health System, University of Florida, Gainesville, FL, USA.,3 Department of Surgery, University of Florida, Gainesville, FL, USA
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Kuhelj D, Avsenik J, Nuredini D. Access From Above-Bailout Solution for Intraoperative Distal Migration of Abdominal Aortic Stent Graft. Vasc Endovascular Surg 2017; 51:338-341. [PMID: 28535733 DOI: 10.1177/1538574417708132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The majority of the ruptured abdominal aortic aneurysms today is treated endovascularly. In cases with short aneurysm neck, chimney technique can be used to extend landing zone in emergency setting. Additionally, the repositioning ability of C3 delivery system (Gore & Associates) allows better positioning in cases with challenging anatomy. In our experience, proximal reposition of partially deployed device can be problematic in some patients. We present a case of endovascular repair of ruptured abdominal aortic aneurysm using chimney technique where proximal reposition was achieved by snaring the aortic device via axillary access.
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Affiliation(s)
- Dimitrij Kuhelj
- 1 Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Jernej Avsenik
- 1 Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Dašmir Nuredini
- 1 Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Tanious A, Lee JT, Shames M. Snorkel endovascular abdominal aortic aneurysm repair versus fenestrated endovascular aneurysm repair: is it a competition? Semin Vasc Surg 2016; 29:68-73. [PMID: 27823593 DOI: 10.1053/j.semvascsurg.2016.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The endovascular treatment of juxtarenal abdominal aortic aneurysm (AAA) can be performed by either a standard endovascular stent graft with additional snorkle grafts to aorta branches (snorkel endovascular aneurysm repair) or implantation of a fenestrated stent graft (fenestrated endovascular aneurysm repair). While many vascular surgeons consider snorkel endovascular aneurysm repair and fenestrated endovascular aneurysm repair to be competing techniques or alternate strategies, published procedural outcomes suggest more complementary roles. In this clinical review, the advantages and disadvantages of these two approaches are debated, as much can be learned from both strategies. Because the indications and circumstances for juxtarenal AAA repair vary based on patient-specific comorbidities and anatomy, it is recommended that vascular surgeons have access to, and experience with, both treatment strategies. Based on published outcomes, patient outcomes, stent-graft patency, and re-intervention rates are generally similar and acceptable compared with open AAA repair. We conclude that there is a time and a place for both snorkel endovascular aneurysm repair and fenestrated endovascular aneurysm repair for the endovascular management of juxtarenal and pararenal AAA anatomy.
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Affiliation(s)
- Adam Tanious
- Division of Vascular and Endovascular Surgery of University of South Florida College of Medicine, Tampa, FL
| | - Jason T Lee
- Divisions of Vascular and Endovascular Surgery of Stanford University, Palo Alto, CA
| | - Murray Shames
- Division of Vascular and Endovascular Surgery of University of South Florida College of Medicine, Tampa, FL.
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Mylonas SN, Moulakakis KG, Kakisis JD, Brountzos EN, Liapis CD. New Chimney after Chimney EVAR for the Treatment of Type Ia Endoleak. Int J Angiol 2015; 25:e126-e130. [PMID: 28031676 DOI: 10.1055/s-0035-1556055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The chimney graft (CG) technique can be a useful alternative in treating aortic aneurysms with challenging anatomy, regarding the proximal sealing zone. We describe the case of a patient who developed a type Ia endoleak after chimney endovascular aneurysm repair for a juxtarenal AAA and underwent a proximal CG reconfiguration and implantation of an aortic cuff. The crossing configuration of the CGs should be avoided as it may compromise the circumferential apposition of the endograft and impede the thrombosis of the perigraft gutters. A proximal reconfiguration of the CGs, in case of type Ia endoleak is a useful option. The long-term efficacy of this option should be evaluated by meticulous follow-up.
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Affiliation(s)
- Spyridon N Mylonas
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Konstantinos G Moulakakis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - John D Kakisis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Elias N Brountzos
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Christos D Liapis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
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9
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Emergent Fully Endovascular Treatment of a Free Ruptured Thoracoabdominal Aneurysm. Ann Vasc Surg 2015; 29:842.e9-13. [DOI: 10.1016/j.avsg.2014.12.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 11/19/2022]
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10
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Loftus IM, Böckler D. Commentary: endovascular aneurysm sealing and chimney grafts: an emergency kit for ruptured pararenal aortic aneurysms? J Endovasc Ther 2015; 22:295-6. [PMID: 25887728 DOI: 10.1177/1526602815582211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ian M Loftus
- St George's Vascular Institute, St George's University of London, London, UK
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
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Dijkstra ML, Lardenoye JW, van Oostayen JA, Zeebregts CJ, Reijnen MM. Endovascular Aneurysm Sealing for Juxtarenal Aneurysm Using the Nellix Device and Chimney Covered Stents. J Endovasc Ther 2014; 21:541-7. [DOI: 10.1583/14-4728mr.1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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Chimney and Periscope Technique for Emergent Treatment of Spontaneous Aortic Rupture. Ann Vasc Surg 2014; 28:1324-8. [DOI: 10.1016/j.avsg.2014.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/23/2013] [Accepted: 01/14/2014] [Indexed: 12/20/2022]
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Hogendoorn W, Schlösser FJ, Aruny JE, Indes JE, Sumpio BE, Muhs BE. Successful Treatment of a Proximal Type I Endoleak With HeliFX EndoAnchors. Ann Vasc Surg 2014; 28:737.e13-7. [DOI: 10.1016/j.avsg.2013.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 06/27/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
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Wilson A, Zhou S, Bachoo P, Tambyraja AL. Systematic review of chimney and periscope grafts for endovascular aneurysm repair. Br J Surg 2014; 100:1557-64. [PMID: 24264776 DOI: 10.1002/bjs.9274] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- A Wilson
- Aberdeen Vascular Surgical Service, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK
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Schlösser FJV, Muhs BE. Commentary: aneurysm rupture after prior AAA repair: endovascular management of the ultimate failure. J Endovasc Ther 2013; 20:619-22. [PMID: 24093313 DOI: 10.1583/13-4260c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Felix J V Schlösser
- 1 Department of Surgery, Section of Vascular Surgery, Yale University School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut, USA
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Hogendoorn W, Schlösser FJ, Moll FL, Sumpio BE, Muhs BE. Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg 2013; 58:502-11. [DOI: 10.1016/j.jvs.2013.03.043] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 03/08/2013] [Accepted: 03/24/2013] [Indexed: 10/26/2022]
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Abstract
PURPOSE OF REVIEW To review the current state of diagnosis, treatment, and outcomes of the different types of endoleaks after endovascular abdominal aortic aneurysm repair (endovascular aneurysm repair, EVAR). RECENT FINDINGS Endoleaks are the most frequent complication after EVAR, the most common indication for secondary interventions, and the most common cause of rupture after EVAR. Imaging is critical for detecting endoleaks. Type I and III endoleaks require urgent intervention to prevent aneurysm rupture. Intervention for other endoleaks or endotension is indicated if the aneurysm sac continues to grow during follow-up. The majority of endoleaks can be treated with endovascular techniques. Open surgical conversion may be considered if the risk of aneurysm rupture is high and if no endovascular options are available or if they have failed. SUMMARY Endoleaks continue to be a challenge and this article discusses the different treatment options for endoleaks after EVAR. Long-term follow-up after EVAR is required to diagnose and treat endoleaks before they result in aneurysm rupture. The majority of endoleaks can be treated with endovascular techniques, although open surgical interventions may be required in selected patients.
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Kawamura M, Kuratani T, Shirakawa Y, Torikai K, Shimamura K, Kin K, Sawa Y. Scallop technique of urgent endovascular repair for symptomatic throacoabdominal aortic aneurysm with a ready-made device. Ann Vasc Surg 2013; 27:239.e5-8. [PMID: 23380556 DOI: 10.1016/j.avsg.2012.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 02/06/2012] [Accepted: 10/07/2012] [Indexed: 11/19/2022]
Abstract
A 72-year-old woman had a large thoracoabdominal aortic aneurysm (TAAA) with abdominal pain. This aneurysm involved the celiac artery and the superior mesenteric artery (SMA). The risk of open surgery was very high due to severe comorbidity, and there was no appropriate distal attachment for thoracic endovascular repair (TEVAR) with ready-made devices. Therefore, TEVAR with the scallop technique was performed in this urgent setting. A scallop was created in a Talent thoracic stent graft. The aneurysm was successfully excluded, and perfusion in the SMA was preserved using this scalloped endograft. The scallop technique with a ready-made device may be one of the treatment options for urgent TAAA.
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Affiliation(s)
- Masashi Kawamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Schlösser FJ, Muhs BE. Commentary: Midterm Results of Endovascular Aortic Repair With Chimney Stent-Grafts. J Endovasc Ther 2013; 20:7-12. [DOI: 10.1583/12-4029c.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chimney grafts preserve visceral flow and allow safe stenting of juxtarenal aortic occlusion. J Vasc Surg 2013; 57:399-405. [PMID: 23219515 DOI: 10.1016/j.jvs.2012.08.108] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 08/17/2012] [Accepted: 08/19/2012] [Indexed: 11/23/2022]
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Siani A, Accrocca F, Gabrielli R, Marcucci G. Is the chimney graft technique a safe and feasible approach to treat urgent aneurysm and pseudoaneurysm of the abdominal aorta? An analysis of our experience and technical considerations. Interact Cardiovasc Thorac Surg 2013; 16:692-4. [PMID: 23335653 DOI: 10.1093/icvts/ivs572] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The chimney graft (CG) technique, based on the deployment of a covered stent parallel to the aortic endograft, has been proposed to achieve a safe proximal fixation extending the sealing zone. We report our experience with the CG technique in an emergency setting. Between December 2010 and April 2012, 4 patients underwent the CG technique. The mean age was 79 (range 76-82 years) and 3 patients were men. The median aneurysm diameter was 64.7 mm (range 63-68 mm). Indications for CG were painful proximal para-anastomotic aneurysm in 2 cases and symptomatic juxtarenal aneurysm in the other 2. Target vessels were both the renal arteries. Technical success was achieved in 100% and no intraoperative complications occurred. No stent-related complications, or Type I endoleak, were detected. No death occurred during the postoperative course. Creatinine elevation was observed in 2 cases. At follow-up, no endoleaks or rupture occurred. One patient died of myocardial infarction 3 months after the procedure. The primary patency rate of covered stents was 100%. The CG technique seems to be safe and feasible with an excellent patency rate of covered stents and a low incidence of endoleaks. More evidence in the literature is needed to carry out a validation of this technique in an emergency.
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Affiliation(s)
- Andrea Siani
- Unit of Vascular and Endovascular Surgery, San Paolo Hospital, Civitavecchia, Rome, Italy.
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Shuja F, Kwolek CJ. Treating the Paravisceral Aorta with Parallel Endografts (Chimneys and Snorkels). Semin Vasc Surg 2012. [DOI: 10.1053/j.semvascsurg.2012.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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"Kissing stents" as an adjunct to thoracic endovascular aortic repair: warts and all. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 7:295-9. [PMID: 23123998 DOI: 10.1097/imi.0b013e31826e03b9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 75-year-old man presented with symptomatic thoracic aneurysm involving the origin of the left subclavian artery. To obtain an adequate landing zone, a simultaneous stent was placed in the left common carotid artery. Until fenestrated and branch graft technology is more available, snorkel approaches may be an acceptable approach for patients with contraindications to open repair.
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Smeds MR, Ofstein R, Peterson GJ, Peterson BG, Jacobs DL. Endovascular repair of a para-anastomotic pseudoaneurysm after renal autotransplantation: an alternative to open reconstruction. Ann Vasc Surg 2012; 27:110.e5-8. [PMID: 23079504 DOI: 10.1016/j.avsg.2012.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 05/24/2012] [Accepted: 06/05/2012] [Indexed: 12/16/2022]
Abstract
Renal artery anastomotic pseudoaneurysms are rare after renal transplantation. The etiology tends to be technical, infectious, or degenerative, and repair is difficult with a high postsurgical complication rate. We report the first case of a complex autotransplant renal artery pseudoaneurysm repaired with kissing covered stents. A 52-year-old woman presented with severe left lower quadrant abdominal pain 6 years after a renal autotransplant for ureteral stenosis and recurrent pyelonephritis. A computed tomographic angiography (CTA) scan revealed a bilobed aneurysm arising at the anastomosis between the renal and common iliac arteries. Kissing covered stents were placed within the common iliac artery proximally and extending into the transplant renal artery and external iliac artery. Postdeployment angiography confirmed complete exclusion of the pseudoaneurysm and excellent flow into the transplant kidney and left lower extremity. A follow-up CTA scan at 1 month revealed continued stent-graft patency and complete exclusion of the pseudoaneurysm. An endovascular approach to transplant anastomotic pseduoaneurysms using kissing covered stents is a viable option to exclude aneurysmal changes and preserve flow to the transplanted organ in carefully selected patients.
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Affiliation(s)
- Matthew R Smeds
- Department of Surgery, Division of Vascular Surgery, Saint Louis University Hospital, 3635 Vista Avenue at Grand Boulevard, St. Louis, MO 63110, USA.
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Antoniou GA, Schiro A, Antoniou SA, Farquharson F, Murray D, Smyth JV, Serracino-Inglott F. Chimney technique in the endovascular management of complex aortic disease. Vascular 2012; 20:251-61. [DOI: 10.1258/vasc.2011.ra0056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this study was to systematically review the literature reporting on the chimney technique and perform an analysis of the outcomes. A search of electronic databases was undertaken to identify all studies reporting on the outcome of the chimney technique. The selected articles were divided into those reporting on the treatment of aortic pathology involving the visceral and those involving the supra-aortic branches. Twenty-one articles reporting on the treatment of juxta/supra-renal aorta and aortic arch disease in 102 and 37 patients, respectively, were identified. In the visceral group, an overall technical success rate of 91% was achieved, the perioperative major morbidity and mortality rates were 17 and 5%, respectively, and an early type I endoleak developed in 13 patients (13%). During follow-up, one patient died of intestinal ischemia. In the supra-aortic group, the technical success rate was recorded in 95%, and three patients (8%) developed an early type I endoleak. Three patients (13%) required conversion to open surgery during follow-up. In conclusion, this technique may be viewed as a complementary technique in high-surgical-risk patients.
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Affiliation(s)
- George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL
| | - Andrew Schiro
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL
| | - Stavros A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL
| | - Finn Farquharson
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL
| | - David Murray
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL
| | - J Vincent Smyth
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL
| | - Ferdinand Serracino-Inglott
- Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL
- Cardiovascular Medicine Research Group, Research School of Clinical and Laboratory Sciences within the School of Medicine, The University of Manchester, Manchester M13 9NT, UK
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Schlösser FJV, Muhs BE. Commentary: the chimney and periscope graft technique: emergent endovascular solutions for rupture of the visceral abdominal aorta. J Endovasc Ther 2012; 19:563-4. [PMID: 22891842 DOI: 10.1583/jevt-12-3912c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Papazoglou KO, Karkos CD, Giagtzidis IT, Kalogirou TE, Eliescu A. Spontaneous Rupture of the Visceral Abdominal Aorta: Endovascular Management Using the Periscope Graft Technique. J Endovasc Ther 2012; 19:558-62. [DOI: 10.1583/12-3912r.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kolvenbach RR, Karmeli R, Bachar-Rubinstein A. Current role of chimneys and sandwich grafts in complex aneurysm repair. Interv Cardiol 2012. [DOI: 10.2217/ica.12.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Karmy-Jones R, Nicholls SC. “Kissing Stents” as an Adjunct to Thoracic Endovascular Aortic Repair Warts and All. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012. [DOI: 10.1177/155698451200700411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Riyad Karmy-Jones
- From Thoracic and Vascular Surgery, Southwest Washington Medical Center, Vancouver, WA USA
| | - Stephen C. Nicholls
- From Thoracic and Vascular Surgery, Southwest Washington Medical Center, Vancouver, WA USA
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Moulakakis KG, Mylonas SN, Avgerinos E, Papapetrou A, Kakisis JD, Brountzos EN, Liapis CD. The chimney graft technique for preserving visceral vessels during endovascular treatment of aortic pathologies. J Vasc Surg 2012; 55:1497-503. [PMID: 22236883 DOI: 10.1016/j.jvs.2011.10.009] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Revised: 09/20/2011] [Accepted: 10/02/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Konstantinos G Moulakakis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece.
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Pecoraro F, Pfammatter T, Mayer D, Frauenfelder T, Papadimitriou D, Hechelhammer L, Veith FJ, Lachat M, Rancic Z. Multiple Periscope and Chimney Grafts to Treat Ruptured Thoracoabdominal and Pararenal Aortic Aneurysms. J Endovasc Ther 2011; 18:642-9. [DOI: 10.1583/11-3556.1] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Brechtel K, Ketelsen D, Endisch A, Heller S, Heuschmid M, Stock UA, Kalender G. Endovascular Repair of Acute Symptomatic Pararenal Aortic Aneurysm With Three Chimney and One Periscope Graft for Complete Visceral Artery Revascularization. Cardiovasc Intervent Radiol 2011; 35:413-7. [DOI: 10.1007/s00270-011-0209-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 05/29/2011] [Indexed: 12/19/2022]
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