Long-term outcomes of chimney endovascular aneurysm repair procedure for complex abdominal aortic pathologies

Paolo Verlato; Leonardo Foresti; Trijntje Bloemert-Tuin; Santi Trimarchi; Constantijn E V B Hazenberg; Joost A van Herwaarden

doi:10.1016/j.jvs.2024.03.448

Long-term outcomes of chimney endovascular aneurysm repair procedure for complex abdominal aortic pathologies

J Vasc Surg. 2024 Apr 9:S0741-5214(24)00935-2. doi: 10.1016/j.jvs.2024.03.448. Online ahead of print.

Authors

Paolo Verlato¹, Leonardo Foresti², Trijntje Bloemert-Tuin³, Santi Trimarchi⁴, Constantijn E V B Hazenberg³, Joost A van Herwaarden³

Affiliations

¹ Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Postgraduate School of Vascular Surgery, University of Milan, Milan, Italy.
² Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Postgraduate School of Vascular Surgery, University of Milan, Milan, Italy. Electronic address: leonardo.foresti@unimi.it.
³ Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
⁴ Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.

PMID: 38604322
DOI: 10.1016/j.jvs.2024.03.448

Abstract

Objective: The aim of this study was to update our earlier experience and to evaluate long-term outcomes of chimney endovascular aortic repair performed for selected cases with complex abdominal aortic aneurysm.

Methods: A single-center retrospective cohort study was conducted on 51 consecutive patients who underwent chimney endovascular aortic repair procedure, deemed unfit for open surgical repair and fenestrated endovascular aneurysm repair, from October 2009 to November 2019. Kaplan-Meier analyses were used to assess the estimated overall survival, freedom from aneurysm related mortality, freedom from reintervention, freedom from target vessel instability, and freedom from type Ia endoleaks.

Results: Fifty-one patients (mean age, 77.1 ± 7.5 years) with a mean preoperative maximum aneurysm diameter of 74.2 ± 20.1 mm were included. Mean follow-up duration was 48.6 months (range, 0-136 months). Estimated overall survival at 5 and 7 years was 36.3% ± 7.1% and 18.3% ± 6.0%, respectively. Freedom from aneurysm-related mortality was 88.6% ± 4.9% at 7 years. Estimated freedom from type Ia endoleaks at 7 years was 91.8% ± 3.9%. A total of 21 late reinterventions were performed in 17 patients (33%). Most of them were performed to treat type II endoleaks with sac growth (47.6%; n = 10) and type Ib endoleak (23.8%; n = 5). Estimated freedom from reintervention at 7 years was 56.3% ± 7.9%. Estimated freedom from target vessel instability at 7 years was 91.5% ± 4.1%.

Conclusions: The 7-year results of chimney endovascular aortic repair procedures performed in our center confirm the long-term safety and effectiveness of this technique in a series of high-risk patients with large aneurysms. The present study has, to the best of our knowledge, the longest follow-up for patients treated with chimney endovascular aortic repair, and it provides data to the scarce literature on the long-term outcomes of this procedure, showing acceptable to good long-term results.

Keywords: Abdominal aortic aneurysms; ChEVAR; Chimney; Chimney grafts; Endovascular aneurysm repair.