title: Innovative application of available stent grafts in Japan in aortic aneurysm treatment-significance of innovative debranching and chimney method and coil embolization procedure.
abstract: OBJECTIVE
  We here describe our experience with innovative uses of these devices.
  
  
  METHODS
  We reviewed treatment outcomes of 310 endovascular abdominal aortic repair (EVAR) and 83 thoracic endovascular aortic repair (TEVAR) cases performed between August 2007 and February 2012. We separately assessed results in elderly and high-risk patients who had a novel procedure. This group included 94 patients who underwent EVAR with IIA embolization, 10 patients who had EVAR and a renal artery chimney procedure for a short aortic neck, 20 patients who had two de-branching TEVAR or Chimney method for thoracic aortic aneurysms (TAA) and 3 patients who had debranching TEVAR for thoracic abdominal aortic aneurysms (TAAA).
  
  
  RESULTS
  Of the 393 patients given stent grafts (SGs), 3 (0.8%) died in the hospital, including 1 patient with pneumonia who underwent EVAR and IIA embolization and 1 patient with a cerebral infarction who had TEVAR. Four patients (4.3%) who were treated with EVAR with internal iliac artery (IIA) embolization presented with residual buttock claudication 6 months postoperatively, and 3 patients (3.2%) had onset of ischemic enteritis; however, in all 7 patients, the condition resolved without additional intervention. In the 10 patients who had EVAR and a renal artery chimney method, the landing zone (LZ) was ≤10 mm, but neither endoleak nor renal artery occlusion was observed perioperatively or during midterm follow-up. Of the 20 patients who had a 2-debranching TEVAR, including 9 in whom the chimney method was used with the LZ in zone 0, 1 (5%) had a residual endoleak. In 3 patients with TAAA, we used SGs to cover 4 abdominal branches and bypassed the visceral artery; the outcomes were good, with all patients being ambulatory at hospital discharge.
  
  
  CONCLUSIONS
  Among innovative SGs treatments, the debranching procedure and the chimney method using catheterization and the coil-embolization technique provided good outcomes, as used in addition to surgical procedures. Aortic aneurysm treatment will become increasingly noninvasive with the continuing development of more innovative ways to use the SGs currently available in Japan. (English Translation of Jpn J Vasc Surg 2012; 21: 165-173).
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Fukui
authors.forename: Yuko
authors.initials: Y
authors.lastname: Wada
authors.forename: Kazunori
authors.initials: K
authors.lastname: Komatsu
authors.forename: Taisi
authors.initials: T
authors.lastname: Fujii
authors.forename: Noburo
authors.initials: N
authors.lastname: Ohashi
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Terasaki
authors.forename: Tatsuichiro
authors.initials: T
authors.lastname: Seto
authors.forename: Tamaki
authors.initials: T
authors.lastname: Takano
authors.forename: Jun
authors.initials: J
authors.lastname: Amano
keywords: aortic aneurysm; chimney method; coil embolization; debranching procedure; stentgraft