title: A 12-Year Experience With Chimney and Periscope Grafts for Treatment of Type I Endoleaks.
abstract: OBJECTIVE
  To evaluate the midterm outcomes of chimney and/or periscope grafts (CPGs) in patients presenting type I endoleak after a previous endovascular aneurysm repair (EVAR).
  
  
  METHODS
  Between June 2002 and April 2014, 24 consecutive patients (mean age 73.9±9.2 years; 23 men) presenting a type I endoleak were addressed with CPGs to extend the proximal and/or distal landing zone and to maintain side branch perfusion. Indication for treatment was a type Ia endoleak in 23 (96%) patients and a type Ib endoleak in one. Median interval from the previous EVAR to endoleak treatment with CPGs was 52.2±48.9 months (range 0.2-179). All patients had proximal/distal landing zones precluding any standard endovascular reintervention. Measured outcomes included technical success and perioperative mortality and morbidity. Technical success was defined as a procedure completed as intended, with no secondary procedures within 30 days. Midterm outcomes included survival, CPG patency, endoleaks, and freedom from reintervention.
  
  
  RESULTS
  Technical success was 96%; a single patient required an additional procedure to seal a recurrent type Ia endoleak. Intraoperative revascularization of all 55 target vessels (2.3/patient) with CPGs was successful. One (4%) patient died within 30 days. Estimated survival at 12, 24, and 36 months was 83%; estimated CPG patency at the same intervals was 94%. Over a mean follow-up of 23.4±29 months, 6 (25%) reinterventions were performed; of these, 4 were secondary to type I endoleak. Aneurysm diameters reduced from 88.3±26 to 85.5±33 mm (p=0.49) over the mean follow-up.
  
  
  CONCLUSIONS
  The CPG technique is a safe and effective tool for treatment of type I endoleak after previous EVAR. The CPG technique is feasible even in nonelective patients, with excellent outcomes in terms of patency. Close imaging follow-up is warranted to rule out recurrent or de novo endoleaks.
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland Department of Surgery "P. Valdoni," Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
authors.forename: Nunzio
authors.initials: N
authors.lastname: Montelione
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland Vascular Surgery Unit, University of Palermo, AOUP "P. Giaccone," Palermo, Italy felicepecoraro@libero.it.
authors.forename: Felice
authors.initials: F
authors.lastname: Pecoraro
authors.affiliation: Interventional Radiology, University Hospital Zurich, Switzerland.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Puippe
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland.
authors.forename: Lyubov
authors.initials: L
authors.lastname: Chaykovska
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Rancic
authors.affiliation: Interventional Radiology, University Hospital Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfammatter
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland.
authors.forename: Dieter
authors.initials: D
authors.lastname: Mayer
authors.affiliation: Clinic for Angiology, University Hospital Zurich, Switzerland.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Amann-Vesti
authors.affiliation: Clinic for Angiology, University Hospital Zurich, Switzerland.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Husmann
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland The Cleveland Clinic, Cleveland, OH, and New York University Medical Center, New York, NY, USA.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Veith
authors.affiliation: Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mangialardi
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland.
authors.forename: Mario
authors.initials: M
authors.lastname: Lachat
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D057867:Endoleak / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence; D015996:Survival Rate; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: abdominal aortic aneurysm; chimney graft; endoleak; endovascular aneurysm repair; morbidity; mortality; parallel graft; pararenal aortic aneurysm; patency; periscope graft; reintervention; self-expanding covered stent; stent-graft; target vessel; thoracoabdominal aortic aneurysm