title: Comparison of fenestrated endovascular aneurysm repair and chimney graft techniques for pararenal aortic aneurysm.
abstract: OBJECTIVE
  This study compared early-term and midterm results of endovascular repair (EVAR) of juxtarenal or pararenal aortic aneurysms (PAAs) using fenestrated stent grafting (f-EVAR) and the chimney grafting (c-EVAR) technique.
  
  
  METHODS
  Consecutive patients with PAAs who underwent f-EVAR using commercially available devices and c-EVAR in a tertiary vascular center from January 2006 to April 2013 were evaluated, including a retrospective scrutiny and update of a prospectively maintained database, calculation and comparison of perioperative mortality and morbidity, overall survival, reintervention-free rate, branch event-free rate, reconstructed vessel patency, and collection of data about intraoperative events, perioperative complications and reinterventions, and midterm sac behavior.
  
  
  RESULTS
  During the study period, 80 patients (72 men) underwent f-EVAR and 38 (34 men) underwent c-EVAR. All f-EVAR patients were operated on electively, whereas six c-EVAR patients (15.8%; P = .002) were operated on in an emergent setting. The preoperative PAA diameter was significantly smaller in the f-EVAR group than in the c-EVAR group (58.6 ± 8.6 mm vs 65.9 ± 15.3 mm; P = .003). The mean number of reconstructed vessels per patient was 2.4 ± 0.7 (median, two) for the f-EVAR group and 1.6 ± 0.7 (median, one) for the c-EVAR group (P < .0001). The f-EVAR and c-EVAR groups did not differ in 30-day mortality (6.3% vs 7.9%; P = .71) or in moderate to severe complications (27.5% vs 39.5%; P = 1.0). Median follow-up duration was 14 months, (range, 0-88 months) in the f-EVAR group and 12 months (range, 0-48 months) in the c-EVAR group. After 2 years, estimated survival rates (77.3% vs 71.8%), reintervention-free rates (71.4% vs 72.0%), reconstructed vessel event-free rates (90.5% vs 84.1%), and primary patency of reconstructed vessel rates (97.1% vs 87.6%) were not statistically different. During follow-up, sac shrinkage (≥5 mm) was observed in 43.4% of f-EVAR patients and in 30.6% of c-EVAR patients (no statistical difference).
  
  
  CONCLUSIONS
  In this limited retrospective series, short-term and midterm results of f-EVAR and c-EVAR were not statistically different. c-EVAR could be an attractive option for patients not suitable for f-EVAR.
authors.affiliation: Department of Vascular Surgery, Henri Mondor Hospital, University Paris XII, Créteil, France. Electronic address: hiroshib@gmail.com.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Banno
authors.affiliation: Department of Vascular Surgery, Henri Mondor Hospital, University Paris XII, Créteil, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Cochennec
authors.affiliation: Department of Vascular Surgery, Henri Mondor Hospital, University Paris XII, Créteil, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Marzelle
authors.affiliation: Department of Vascular Surgery, Henri Mondor Hospital, University Paris XII, Créteil, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Becquemin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D018572:Disease-Free Survival; D057867:Endoleak / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007668:Kidney; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D058017:Vascular Grafting / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D014654:Vascular Patency