title: Collected world experience about the performance of the snorkel/chimney endovascular technique in the treatment of complex aortic pathologies: the PERICLES registry.
abstract: OBJECTIVE
  We sought to analyze the collected worldwide experience with use of snorkel/chimney endovascular aneurysm repair (EVAR) for complex abdominal aneurysm treatment.
  
  
  BACKGROUND
  EVAR has largely replaced open surgery worldwide for anatomically suitable aortic aneurysms. Lack of availability of fenestrated and branched devices has encouraged an alternative strategy utilizing parallel or snorkel/chimney grafts (ch-EVAR).
  
  
  METHODS
  Clinical and radiographic information was retrospectively reviewed and analyzed on 517 patients treated by ch-EVAR from 2008 from 2014 by prearranged defined and documented protocols.
  
  
  RESULTS
  A total of 119 patients in US centers and 398 in European centers were treated during the study period. US centers preferentially used Zenith stent-grafts (54.2%) and European centers Endurant stent-grafts (62.2%) for the main body component. Overall 898 chimney grafts (49.2% balloon expandable, 39.6% self-expanding covered stents, and 11.2% balloon expandable bare metal stents) were placed in 692 renal arteries, 156 superior mesenteric arteries (SMA), and 50 celiac arteries. At a mean follow-up of 17.1 months (range: 1-70 months), primary patency was 94%, with secondary patency of 95.3%. Overall survival of patients in this high-risk cohort for open repair at latest follow-up was 79%.
  
  
  CONCLUSIONS
  This global experience represents the largest series in the ch-EVAR literature and demonstrates comparable outcomes to those in published reports of branched/fenestrated devices, suggesting the appropriateness of broader applicability and the need for continued careful surveillance. These results support ch-EVAR as a valid off-the-shelf and immediately available alternative in the treatment of complex abdominal EVAR and provide impetus for the standardization of these techniques in the future.
authors.affiliation: *Department of Vascular Surgery, St. Franziskus-Hospital Münster, Münster, Germany †Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA ‡Division of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland §Department of Vascular Surgery, St. Franziskus-Hospital Münster, and Clinic for Vascular and Endovascular Surgery, University of Münster, Münster, Germany ¶Division of Vascular Surgery, New York University Medical Center, New York, NY.
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Donas
authors.forename: Jason T
authors.initials: JT
authors.lastname: Lee
authors.forename: Mario
authors.initials: M
authors.lastname: Lachat
authors.forename: Giovanni
authors.initials: G
authors.lastname: Torsello
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Veith
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States