A 12-Year Experience With Chimney and Periscope Grafts for Treatment of Type I Endoleaks

Nunzio Montelione; Felice Pecoraro; Gilbert Puippe; Lyubov Chaykovska; Zoran Rancic; Thomas Pfammatter; Dieter Mayer; Beatrice Amann-Vesti; Marc J Husmann; Frank J Veith; Nicola Mangialardi; Mario Lachat

doi:10.1177/1526602815586972

A 12-Year Experience With Chimney and Periscope Grafts for Treatment of Type I Endoleaks

J Endovasc Ther. 2015 Aug;22(4):568-74. doi: 10.1177/1526602815586972. Epub 2015 May 12.

Authors

Affiliations

¹ Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland Department of Surgery "P. Valdoni," Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
² Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland Vascular Surgery Unit, University of Palermo, AOUP "P. Giaccone," Palermo, Italy felicepecoraro@libero.it.
³ Interventional Radiology, University Hospital Zurich, Switzerland.
⁴ Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland.
⁵ Clinic for Angiology, University Hospital Zurich, Switzerland.
⁶ Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland The Cleveland Clinic, Cleveland, OH, and New York University Medical Center, New York, NY, USA.
⁷ Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy.

PMID: 25969150
DOI: 10.1177/1526602815586972

Abstract

Purpose: To evaluate the midterm outcomes of chimney and/or periscope grafts (CPGs) in patients presenting type I endoleak after a previous endovascular aneurysm repair (EVAR).

Methods: Between June 2002 and April 2014, 24 consecutive patients (mean age 73.9±9.2 years; 23 men) presenting a type I endoleak were addressed with CPGs to extend the proximal and/or distal landing zone and to maintain side branch perfusion. Indication for treatment was a type Ia endoleak in 23 (96%) patients and a type Ib endoleak in one. Median interval from the previous EVAR to endoleak treatment with CPGs was 52.2±48.9 months (range 0.2-179). All patients had proximal/distal landing zones precluding any standard endovascular reintervention. Measured outcomes included technical success and perioperative mortality and morbidity. Technical success was defined as a procedure completed as intended, with no secondary procedures within 30 days. Midterm outcomes included survival, CPG patency, endoleaks, and freedom from reintervention.

Results: Technical success was 96%; a single patient required an additional procedure to seal a recurrent type Ia endoleak. Intraoperative revascularization of all 55 target vessels (2.3/patient) with CPGs was successful. One (4%) patient died within 30 days. Estimated survival at 12, 24, and 36 months was 83%; estimated CPG patency at the same intervals was 94%. Over a mean follow-up of 23.4±29 months, 6 (25%) reinterventions were performed; of these, 4 were secondary to type I endoleak. Aneurysm diameters reduced from 88.3±26 to 85.5±33 mm (p=0.49) over the mean follow-up.

Conclusion: The CPG technique is a safe and effective tool for treatment of type I endoleak after previous EVAR. The CPG technique is feasible even in nonelective patients, with excellent outcomes in terms of patency. Close imaging follow-up is warranted to rule out recurrent or de novo endoleaks.

Keywords: abdominal aortic aneurysm; chimney graft; endoleak; endovascular aneurysm repair; morbidity; mortality; parallel graft; pararenal aortic aneurysm; patency; periscope graft; reintervention; self-expanding covered stent; stent-graft; target vessel; thoracoabdominal aortic aneurysm.

MeSH terms

Aged
Aortic Aneurysm, Abdominal / surgery*
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation / methods*
Endoleak / surgery*
Endovascular Procedures*
Female
Humans
Male
Recurrence
Survival Rate
Treatment Outcome
Vascular Patency