title: Endovascular Repair of Paravisceral Aortic Aneurysms Combining Chimney Grafts and the Nellix Endovascular Aneurysm Sealing Technology (Four-Vessel ChEVAS).
abstract: BackgroundWe demonstrate our initial experience and first results of the endovascular aneurysm sealing (EVAS) technology with chimney grafts for the treatment of paravisceral aneurysms.MethodsWe present a consecutive series of seven patients with a mean age of 75 years who had been treated by four-vessel-chimney EVAS (ChEVAS) between May 2014 and May 2015. All patients were ASA grade ≥ III and were not eligible for fenestrated/branched endovascular aortic repair (fEVAR/brEVAR) due to urgency (n= 5) or anatomical constraints (n= 2).ResultsTotal 28 renovisceral target vessels were treated by balloon-expandable covered stents and 14 Nellix devices were used to seal the paravisceral aorta. Overall, 16 Nellix (Endologix Inc., Irvine, California, United States) devices and 65 covered stents were implanted with a technical success of 100%. Perioperatively, one patient with ruptured aneurysm died due to respiratory failure following splenic laceration/splenectomy (mortality = 14%) and in one patient, laceration of an axillary access vessel occurred. At a median follow-up of 6 months, all six surviving patients were well and no reinterventions were necessary. One chimney was found occluded without clinical sequelae resulting in a patency rate of 96%.ConclusionFour-vessel ChEVAS may serve as alternative treatment option in highly selected cases of either acute paravisceral aortic pathology and/or situations, where the implantation of fEVAR/brEVAR is hampered by anatomical constraints. Further follow-up and a multicenter study are of course warranted to corroborate these initial results.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz-Mainz, Germany.
authors.forename: Marwan
authors.initials: M
authors.lastname: Youssef
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz-Mainz, Germany.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Dünschede
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz-Mainz, Germany.
authors.forename: Hazem
authors.initials: H
authors.lastname: El Beyrouti
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz-Mainz, Germany.
authors.forename: Ora
authors.initials: O
authors.lastname: Salem
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz-Mainz, Germany.
authors.forename: Christian-Friedrich
authors.initials: CF
authors.lastname: Vahl
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz-Mainz, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Dorweiler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency