Advertisement

Sealing Devices in Chimney Aortic Repair (CH EVAS) Versus Chimney Aortic Repair with Conventional Devices (CH EVAR): A Systematic Review

  • Daniela MazzaccaroEmail author
  • Alberto M. Settembrini
  • Lorenzo Muzzarelli
  • Federico Ambrogi
  • Valentina Milani
  • Giovanni Nano
Review Arterial Interventions
  • 36 Downloads
Part of the following topical collections:
  1. Arterial Interventions

Abstract

Aim

The aim of this study was to review the literature about the occurrence of postoperative type I endoleak (EL) and chimney graft thrombosis (CGT) after the use of sealing devices in chimney endovascular aortic repair (Ch EVAS), compared to chimney EVAR using conventional devices (Ch EVAR).

Methods

A systematic review of the literature on PubMed and MEDLINE with the terms “Chimney” and “Parallel grafts” was performed. The review was set up following the PRISMA guidelines. Case series about the use of the chimney/snorkel technique during endovascular repair of juxtarenal/pararenal aneurysms (AAA) were considered. Only papers with full text available in English and reporting complete data with at least 1 month of follow-up about at least 5 cases were included in the analysis.

Results

In total, 90 papers were assessed for eligibility. According to the inclusion criteria, only 25 papers could be analyzed (20 in the Ch EVAR group and 5 in the Ch EVAS group). A type I EL occurred in 9.3% after Ch EVAR (95% CI 7.1–12.2%) and in 8.3% after Ch EVAS (95% CI 3.5–18.5%), being not significantly different. CGT occurred in 10.7% of cases after Ch EVAR (95% CI 8.8–13%) and in 8.8% of cases after Ch EVAS (95% CI 3.3–21.3%), being also not significantly different.

Conclusions

The reported rate of type I EL and CGT occurring after Ch EVAR tended to be slightly higher than those reported after Ch EVAS, even if the difference was not statistically significant.

Keywords

Chimney graft/technique EVAR EVAS Abdominal aortic aneurysm Aneurysm sealing 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Donas KP, Torsello GB, Piccoli G, Pitoulias GA, Torsello GF, Bisdas T, et al. The PROTAGORAS study to evaluate the performance of the Endurant stent graft for patients with pararenal pathologic processes treated by the chimney/snorkel endovascular technique. J Vasc Surg. 2016;63(1):1–7.CrossRefGoogle Scholar
  2. 2.
    Katsargyris A, Oikonomou K, Klonaris C, Topel I, Verhoeven EL. Comparison of outcomes with open, fenestrated, and chimney graft repair of juxtarenal aneurysms: are we ready for a paradigm shift? J Endovasc Ther. 2013;20:159e69.CrossRefGoogle Scholar
  3. 3.
    Katsargyris A, Oikonomou K, Klonaris C, Topel I, Verhoeven EL. Comparison of outcomes with open, fenestrated, and chimney graft repair of juxtarenal aneurysms: are we ready for a paradigm shift? J Endovasc Ther. 2013;20:159–69.CrossRefGoogle Scholar
  4. 4.
    Carpenter JP, Cuff R, Buckley C, Healey C, Hussain S, Reijnen MM, Trani J, Böckler D, Nellix Investigators. One-year pivotal trial outcomes of the Nellix system for endovascular aneurysm sealing. J Vasc Surg. 2017;65(2):330–336.e4.CrossRefGoogle Scholar
  5. 5.
    Youssef M, Zerwes S, Jakob R, Salem O, Dünschede F, Vahl CF, et al. Endovascular aneurysm sealing (EVAS) and chimney EVAS in the treatment of failed endovascular aneurysm repairs. J Endovasc Ther. 2016;24(1):115–20.CrossRefGoogle Scholar
  6. 6.
    Boersen JT, Donselaar EJ, Groot Jebbink E, Starreveld R, Overeem SP, Slump CH, de Vries JPM, Reijnen MMPJ. Benchtop quantification of gutter formation and compression of chimney stent grafts in relation to renal flow in chimney endovascular aneurysm repair and endovascular aneurysm sealing configurations. J Vasc Surg. 2017;66:1565–73.CrossRefGoogle Scholar
  7. 7.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA Statement for reporting systematic reviews and meta-analysis of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151(4):W11–30.CrossRefGoogle Scholar
  8. 8.
    De Bruin JL, Brownrigg JR, Patterson BO, Karthikesalingam A, Holt PJ, Hinchliffe RJ, et al. The endovascular sealing device in combination with parallel grafts for treatment of juxta/suprarenal abdominal aortic aneurysms: short-term results of a novel alternative. Eur J Vasc Endovasc Surg. 2016;52(4):458–65.CrossRefGoogle Scholar
  9. 9.
    Dinkelman MK, Overeem SP, Bockler D, De Vries JP, Heyligers JM. Chimney technique in combination with a sac-anchoring endograft for juxtarenal aortic aneurysms: technical aspects and early results. J Cardiovasc Surg (Torino). 2016;57(5):730–6.Google Scholar
  10. 10.
    Igari K, Kudo T, Toyofuku T, Inoue Y. The outcomes of endovascular aneurysm repair with the chimney technique for juxtarenal aortic aneurysms. Ann Thorac Cardiovasc Surg. 2016;22(3):174–80.CrossRefGoogle Scholar
  11. 11.
    Abu Bakr N, Torsello G, Pitoulias GA, Stavroulakis K, Austermann M, Donas KP. Preservation of clinically relevant accessory renal arteries in infrarenal AAA patients with adequate proximal landing zones undergoing EVAR. J Endovasc Ther. 2016;23(2):314–20.CrossRefGoogle Scholar
  12. 12.
    Silveira D, Pitoulias G, Torsello G, Donas KP. Outcomes of total endovascular treatment of juxtarenal aortic aneurysms in octogenarians. J Vasc Surg. 2016;63(4):909–14.CrossRefGoogle Scholar
  13. 13.
    Bin Jabr A, Lindblad B, Kristmundsson T, Dias N, Resch T, Malina M. Outcome of visceral chimney grafts after urgent endovascular repair of complex aortic lesions. J Vasc Surg. 2016;63(3):625–33.CrossRefGoogle Scholar
  14. 14.
    Donas KP, Lee JT, Lachat M, Torsello G, Veith FJ, PERICLES investigators. Collected world experience about the performance of the snorkel/chimney endovascular technique in the treatment of complex aortic pathologies: the PERICLES registry. Ann Surg. 2015;262(3):546–53.CrossRefGoogle Scholar
  15. 15.
    Montelione N, Pecoraro F, Puippe G, Chaykovska L, Rancic Z, Pfammatter T, et al. A 12-year experience with chimney and periscope grafts for treatment of type I endoleaks. J Endovasc Ther. 2015;22(4):568–74.CrossRefGoogle Scholar
  16. 16.
    XiaoHui M, Wei G, ZhongZhou H, XiaoPing L, Jiang X, Xin J. Endovascular repair with chimney technique for juxtarenal aortic aneurysm: a single center experience. Eur J Vasc Endovasc Surg. 2015;49(3):271–6.CrossRefGoogle Scholar
  17. 17.
    Scali ST, Feezor RJ, Chang CK, Waterman AL, Berceli SA, Huber TS, et al. Critical analysis of results after chimney endovascular aortic aneurysm repair raises cause for concern. J Vasc Surg. 2014;60(4):865–73.CrossRefGoogle Scholar
  18. 18.
    Tran K, Ullery BW, Lee JT. Snorkel/chimney stent morphology predicts renal dysfunction after complex endovascular aneurysm repair. Ann Vasc Surg. 2016;30:1–11.e1.CrossRefGoogle Scholar
  19. 19.
    Schwierz E, Kolvenbach RR, Yoshida R, Yoshida W, Alpaslan A, Karmeli R. Experience with the sandwich technique in endovascular thoracoabdominal aortic aneurysm repair. J Vasc Surg. 2014;59(6):1562–9.CrossRefGoogle Scholar
  20. 20.
    Ducasse E, Lepidi S, Brochier C, Deglise S, Berard X, Alberti D, et al. The “open” chimney graft technique for juxtarenal aortic aneurysms with discrepant renal arteries. Eur J Vasc Endovasc Surg. 2014;47(2):124–30.CrossRefGoogle Scholar
  21. 21.
    Banno H, Cochennec F, Marzelle J, Becquemin JP. Comparison of fenestrated endovascular aneurysm repair and chimney graft techniques for pararenal aortic aneurysm. J Vasc Surg. 2014;60(1):31–9.CrossRefGoogle Scholar
  22. 22.
    Fukui D, Wada Y, Komatsu K, Fujii T, Ohashi N, Terasaki T, et al. Innovative application of available stent grafts in Japan in aortic aneurysm treatment-significance of innovative debranching and chimney method and coil embolization procedure. Ann Vasc Dis. 2013;6(3):601–11.CrossRefGoogle Scholar
  23. 23.
    Suominen V, Pimenoff G, Salenius J. Fenestrated and chimney endografts for juxtarenal aneurysms: early and midterm results. Scand J Surg. 2013;102(3):182–8.CrossRefGoogle Scholar
  24. 24.
    Liu B, Pan H, Song X, Liu C, Wu W, Chen Y, et al. Chimney stents for endovascular repair of juxtarenal aortic aneurysms with unfavourable anatomy. Int Angiol. 2013;32(3):307–11.PubMedGoogle Scholar
  25. 25.
    Schiro A, Antoniou GA, Ormesher D, Pichel AC, Farquharson F, Serracino-Inglott F. The chimney technique in endovascular aortic aneurysm repair: late ruptures after successful single renal chimney stent grafts. Ann Vasc Surg. 2013;27(7):835–43.CrossRefGoogle Scholar
  26. 26.
    Pecoraro F, Pfammatter T, Mayer D, Frauenfelder T, Papadimitriou D, Hechelhammer L et al (2011) Multiple periscope and chimney grafts to treat ruptured thoracoabdominal and pararenal aortic aneurysms. J Endovasc Ther 18(5):642–649. Erratum in: J Endovasc Ther 18(6):A-5 (2011)Google Scholar
  27. 27.
    Bruen KJ, Feezor RJ, Daniels MJ, Beck AW, Lee WA. Endovascular chimney technique versus open repair of juxtarenal and suprarenal aneurysms. J Vasc Surg. 2011;53(4):895–904.CrossRefGoogle Scholar
  28. 28.
    Ohrlander T, Sonesson B, Ivancev K, Resch T, Dias N, Malina M. The chimney graft: a technique for preserving or rescuing aortic branch vessels in stent-graft sealing zones. J Endovasc Ther. 2008;15(4):427–32.CrossRefGoogle Scholar
  29. 29.
    Ronchey S, Serrao E, Kasemi H, Pecoraro F, Fazzini S, Alberti V, et al. Endovascular treatment options for complex abdominal aortic aneurysms. J Vasc Interv Radiol. 2015;26(6):842–54.CrossRefGoogle Scholar
  30. 30.
    Youssef M, Dünschede F, El Beyrouti H, Salem O, Vahl CF, Dorweiler B. Endovascular repair of paravisceral aortic aneurysms combining chimney grafts and the Nellix endovascular aneurysm sealing technology (Four-Vessel ChEVAS). Thorac Cardiovasc Surg. 2016;65(2):112–9.CrossRefGoogle Scholar
  31. 31.
    Harrison SC, Winterbottom AJ, Coughlin PA, Hayes PD, Boyle JR. Editor’s choice: mid-term migration and device failure following endovascular aneurysm sealing with the Nellix stent graft system—a single centre experience. Eur J Vasc Endovasc Surg. 2018;56:342–8.CrossRefGoogle Scholar
  32. 32.
    Filippi F, Ficarelli R, Tirotti C, Stella N, Taurino M. Emergent fully endovascular treatment of a free ruptured thoracoabdominal aneurysm. Ann Vasc Surg. 2015;29(842):e9–13.Google Scholar
  33. 33.
    Yaoguo Y, Zhong C, Lei K, Yaowen X. Treatment of complex aortic aneurysms with fenestrated endografts and chimney stent repair: systematic review and meta-analysis. Vascular. 2016;25(1):92–100.CrossRefGoogle Scholar
  34. 34.
    Donas KP, Bisdas T, Torsello G, Austermann M. Technical considerations and performance of bridging stent-grafts for iliac side branched devices based on a pooled analysis of single-center experiences. J Endovasc Ther. 2012;19:667–71.CrossRefGoogle Scholar
  35. 35.
    van den Ham LH, Zeebregts CJ, de Vries JP, Reijnen MM. Abdominal aortic aneurysm repair using Nellix endovascular aneurysm sealing. Surg Technol Int. 2015;26:226–31.PubMedGoogle Scholar
  36. 36.
    Fairman AS, Wang GJ, Jackson BM, Foley PJ, Damrauer SM, Kalapatapu V, Golden MA, Fairman RM. Characterization and outcomes of reinterventions in Food and Drug Administration-approved versus trial endovascular aneurysm repair devices. J Vasc Surg. 2017;67(4):1082–90.  https://doi.org/10.1016/j.jvs.2017.08.058.CrossRefPubMedGoogle Scholar
  37. 37.
    Donselaar EJ, Holden A, Zoethout AC, Zeebregts CJ, Reijnen MM. Feasibility and technical aspects of proximal Nellix-in-Nellix extension for late caudal endograft migration. J Endovasc Ther. 2016;24(2):210–7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.First Unit of Vascular SurgeryIRCCS Policlinico San DonatoSan Donato MilaneseItaly
  2. 2.Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
  3. 3.Scientific DirectorateIRCCS Policlinico San DonatoSan Donato MilaneseItaly
  4. 4.Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly

Personalised recommendations