title: Novel indication for chimney graft placement in the inferior mesenteric artery in AAA patients with coexistent bilateral internal iliac artery occlusion.
abstract: OBJECTIVE
  To report a novel indication for the use of chimney grafts to preserve flow to the inferior mesenteric artery (IMA) in patients undergoing endovascular aneurysm repair (EVAR) for aortobi-iliac aneurysms with coexistent bilateral occlusion of the internal iliac arteries (IIA).
  
  
  METHODS
  Via a cutdown over the left axillary artery, a 5-F vertebral catheter was delivered over a conventional 0.035-inch hydrophilic guidewire to selectively catheterize the IMA via a 7-F shuttle sheath, which was then advanced at least 2 cm into the target vessel. The first chimney graft was advanced into the sheath, and a standard EVAR procedure followed. The chimney graft was deployed at least 2 cm in the IMA; a second chimney graft was advanced and deployed with at least 2 cm overlapping with the first chimney stent parallel and outside of the main abdominal endograft and below the lowest renal artery. The chimney grafts were lined with additional bare nitinol stents. The technique is demonstrated in two male patients who suffered from symptomatic aortobi-iliac aneurysm with patent IMAs and bilateral IIA occlusion. The procedure was completed successfully in both cases without bowel ischemia. At 12 and 6 months, respectively, the chimney grafts remained patent without endoleak. The patients are asymptomatic.
  
  
  CONCLUSIONS
  The IMA chimney endovascular technique can be considered in EVAR cases with coexistent bilateral IIA occlusion to minimize the risk for bowel ischemia.
authors.affiliation: 1 Department of Vascular Surgery, St. Franziskus Hospital Münster and Münster University Hospital, Münster, Germany.
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Donas
authors.forename: Giovanni
authors.initials: G
authors.lastname: Torsello
authors.forename: Theodosios
authors.initials: T
authors.lastname: Bisdas
authors.forename: Martin
authors.initials: M
authors.lastname: Austermann
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stavroulakis
authors.forename: Georgios A
authors.initials: GA
authors.lastname: Pitoulias
mesh_terms: D000368:Aged; D000497:Alloys; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000295:instrumentation*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D012039:Regional Blood Flow; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D000497:Alloys; C013616:nitinol
keywords: chimney; colon ischemia; endovascular aneurysm repair; hypogastric artery; inferior mesenteric artery; internal iliac artery; revascularization