title: Mid- and Longer-term Follow up of Chimney and/or Periscope Grafts and Risk Factors for Failure.
abstract: OBJECTIVE
  The aim was to report on chimney and periscope grafts (CPGs) and their mid- and longer-term outcomes when they are used to preserve reno-visceral artery (RVA) perfusion in endovascular repair of pararenal (PRAAs) or thoraco-abdominal aortic aneurysm (TAAAs). In addition, factors associated with CPG failure are presented. Limited data exist on the outcomes of CPGs, and mid- and long-term results are generally not reported.
  
  
  METHODS
  This was a prospective study in a cohort of 100 patients with PRAA (69) or TAAA (31). A total of 224 (mean 2.24 per patient) RVAs were preserved with 136 (61%) chimney and 88 (39%) periscope grafts. CPGs were constructed mainly using self expandable stent grafts. Patients were followed by clinical examination, CTA (82%), and/or duplex (18%). Data were collected until February 2015.
  
  
  RESULTS
  CPG immediate technical success was 99% (222/224 branches). Mean follow up was 29 months (range 0-65; SD 17); 59% patients were followed > 2 years, 30% > 3 years, and 16% > 4 years. Post-operatively, CPG occlusion was observed early (≤30 days) in three (1.3%) branches and during follow up in 10 (4.5%). At 36 and 48 months, the estimated primary patency was 93% and 93%. After corrective percutaneous (10) or surgical (3) re-interventions, the estimated secondary patency was 96% and 96%. Thirty day mortality was 2%; at 36 and 48 months the estimated patient survival was 79%. Significant shrinkage (72 [SD 23] vs. 62 [SD 24] mm; p < .001) was observed, with a substantial reduction (>5 mm) in 55 patients, and sac enlargement in four. Incomplete aneurysm sac sealing was treated successfully by a secondary intervention in 15 patients.
  
  
  CONCLUSIONS
  Self expandable CPGs have proved to be a highly successful and durable treatment for RVA preservation up to 5 years. Incomplete CPG expansion, inadequate length, and CPG use in small and diseased target arteries were risk factors for occlusion. These mid- and longer-term results support CPG use to treat PRAAs or TAAAs in patients unfit for open surgery or fenestrated/branched stent grafts.
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; Vascular Surgery Unit, University of Palermo, AOUP "P. Giaccone", Palermo, Italy. Electronic address: felicepecoraro@libero.it.
authors.forename: F
authors.initials: F
authors.lastname: Pecoraro
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland; New York University - Langone Medical Center, New York and The Cleveland Clinic, United States.
authors.forename: F J
authors.initials: FJ
authors.lastname: Veith
authors.affiliation: Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Puippe
authors.affiliation: Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Amman-Vesti
authors.affiliation: Division of Cardiovascular Anesthesia, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Bettex
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Z
authors.initials: Z
authors.lastname: Rancic
authors.affiliation: Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: T
authors.initials: T
authors.lastname: Pfammatter
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Lachat
mesh_terms: D000368:Aged; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012077:Renal Artery / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D058017:Vascular Grafting / Q000009:adverse effects / Q000379:methods*
keywords: Chimney and periscope graft; Complex aortic aneurysm; Endovascular aneurysm repair; Pararenal aortic aneurysm; Reno-visceral arteries; Thoraco-abdominal aortic aneurysm