title: The "open" chimney graft technique for juxtarenal aortic aneurysms with discrepant renal arteries.
abstract: OBJECTIVE
  A straightforward original Chimney Graft (CG) protocol has been developed at our institution in selected cases of juxtarenal aortic aneurysm (JRAA). The aim of this study was to present our clinical experience of consecutive series with use of uncovered self-expanding stent (SES) as "Open Chimney" (OCh) in the endovascular repair (EVAR) of JRAA.
  
  
  METHODS
  A standard endograft with suprarenal fixation struts is delivered with its proximal covered edge just below the highest RA in JRAA presenting the ostium of the two renal arteries at a different aortic level and the distance between the highest renal artery and the beginning of the aneurysm (improved landing zone) ≥10 mm. The low-lying renal artery is maintained patent by the OCh graft (standard SES) delivered from left brachial access (6 Fr). All clinical, anatomical, and operative data were prospectively collected and retrieved for the study analysis.
  
  
  RESULTS
  From July 2010 to November 2012, OCh EVAR was offered to 22 consecutive patients considered unfit for JRAA open repair. All procedures were technically successful with aneurysm exclusion and patent OCh graft. One small perioperative type Ia endoleak spontaneously disappeared at the 3-month CT control. One patient died because of acute decompensated heart failure. One patient presented a left hemispheric stroke. The median follow-up of 18 months (range 7-35) showed aneurysm exclusion in all patients without type I and III endoleaks, SES stenosis, and/or renal impairment.
  
  
  CONCLUSIONS
  OCh-EVAR is a straightforward technique that can be employed in selected cases of JRAA, avoiding the more complex and expensive fenestrated EVAR.
authors.affiliation: Vascular Surgery Unit, University of Bordeaux, Bordeaux, France.
authors.forename: E
authors.initials: E
authors.lastname: Ducasse
authors.affiliation: Vascular Surgery Unit, University of Bordeaux, Bordeaux, France; Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy. Electronic address: slepidi@unipd.it.
authors.forename: S
authors.initials: S
authors.lastname: Lepidi
authors.affiliation: Vascular Surgery Unit, University of Bordeaux, Bordeaux, France.
authors.forename: C
authors.initials: C
authors.lastname: Brochier
authors.affiliation: Centre Hospitalier Universitaire Vaudois, CHUV, University Hospital of Lausanne, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Deglise
authors.affiliation: Vascular Surgery Unit, University of Bordeaux, Bordeaux, France.
authors.forename: X
authors.initials: X
authors.lastname: Berard
authors.affiliation: Ospedale Belcolle, Viterbo City Hospital, Viterbo, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Alberti
authors.affiliation: Vascular Surgery Unit, University of Bordeaux, Bordeaux, France.
authors.forename: D
authors.initials: D
authors.lastname: Midy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Chimney graft technique; Endovascular repair; Juxtarenal aortic aneurysm; Self-expanding stent