Multiple Periscope and Chimney Grafts to Treat Ruptured Thoracoabdominal and Pararenal Aortic Aneurysms

• Published in: Journal of endovascular therapy Vol. 18; no. 5; pp. 642 - 649
• Main Authors: Pecoraro, Felice, Pfammatter, Thomas, Mayer, Dieter, Frauenfelder, Thomas, Papadimitriou, Dimitri, Hechelhammer, Lukas, Veith, Frank J., Lachat, Mario, Rancic, Zoran
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.10.2011; Allen Press Inc
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysms; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Aortic Rupture - diagnostic imaging; Aortic Rupture - mortality; Aortic Rupture - surgery; Aortography - methods; Blood pressure; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - mortality; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Endovascular Procedures - mortality; Female; Humans; Male; Medical imaging; Middle Aged; Prosthesis Design; Retrospective Studies; Stents; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Veins & arteries; stent-graft; periscope graft; endovascular aneurysm repair; ruptured pararenal aortic aneurysm; chimney graft; ruptured aortic aneurysm; renovisceral arteries; endograft; endodebranching; ruptured AAA; ruptured thoracoabdominal aortic aneurysm
• ISSN: 1526-6028; 1545-1550
• DOI: 10.1583/11-3556.1

Purpose To report midterm outcomes after urgent endovascular repair of ruptured pararenal or thoracoabdominal aortic aneurysms using multiple periscope and chimney grafts to preserve renovisceral branch perfusion and facilitate aneurysm exclusion. Methods Nine consecutive men (mean age 72±14 years, range 40–88) presenting with ruptured thoracoabdominal (n=6), pararenal (n=2), or infrarenal (n=1) aortic aneurysm underwent urgent endovascular repair with at least 1 periscope graft delivered via a transfemoral access; chimney grafts were installed from an axillary access. In all, 17 periscope and 7 chimney grafts were used to reperfuse 11 renal and 13 visceral arteries in the 9 patients. The aortic aneurysms were excluded using thoracic devices (n=7), an aortic extension cuff (n=1), and bifurcated stent-grafts (n=2). Results All procedures were completed without technical complications except for a dislocated stent-graft from the right renal artery; the artery could not be re-accessed, and the right kidney was sacrificed. One patient died of multiple organ failure (11% 30-day mortality). At a mean follow-up of 10 months (range 3–24), 5 of the 9 patients had recovered completely; 3 patients died of unrelated causes. Imaging showed no aneurysm growth in any patient, with a mean 20% shrinkage in aneurysm size. All periscope and chimney grafts remained patent, and no aortic stent-graft migration was observed. Renal function and the glomerular filtration rate remained stable in all patients. Conclusion The periscope and chimney graft technique provides a simpler, less invasive way to maintain blood flow to the renovisceral arteries during urgent endovascular aortic repairs. The very low 30-day mortality rate and the stability of the repairs in the midterm are encouraging. This technique has the potential to profoundly influence the treatment of acute aortic pathologies.