title: Endovascular repair of a ruptured pararenal aortic aneurysm using the Nellix endovascular aneurysm sealing system and chimney grafts.
abstract: OBJECTIVE
  To demonstrate the feasibility of emergent endovascular repair of a ruptured pararenal aneurysm using chimney grafts and the Nellix endovascular aneurysm sealing (EVAS) system to reduce the potential for endoleak from the gutters around the chimney grafts.
  
  
  METHODS
  A 74-year-old patient presented with a ruptured pararenal aneurysm. Because of anatomical considerations after previous aortic surgery, conventional endovascular aneurysm repair was deemed impossible. It was decided to exclude the aneurysm with a Nellix EVAS system in conjunction with two chimneys to the renal arteries, even though this was outside the instructions for use of the device. Active bleeding was stopped directly after positioning the chimneys and filling the endobags with polymer. Completion angiography showed aneurysm exclusion and patent renal arteries. Renal function remained stable, and the patient was discharged at the third postoperative day. At 6 months, duplex ultrasound and computed tomography showed patent stents and chimneys and no evidence of endoleak.
  
  
  CONCLUSIONS
  Using chimney grafts in combination with the Nellix endoprosthesis in a ruptured pararenal aneurysm is feasible. However, more robust data on both chimney-EVAS and EVAS in ruptured cases are required.
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Truijers
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: Steven M M
authors.initials: SM
authors.lastname: van Sterkenburg
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Lardenoije
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands mmpj.reijnen@gmail.com.
authors.forename: Michel M P J
authors.initials: MM
authors.lastname: Reijnen
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D004630:Emergencies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
keywords: abdominal aortic aneurysm; chimney graft; emergent repair; endoleak; endovascular sealing system; parallel graft; pararenal aneurysm; renal artery; ruptured aneurysm