title: Complementary Role of Fenestrated/Branched Endografting and the Chimney Technique in the Treatment of Pararenal Aneurysms After Open Abdominal Aortic Repair.
abstract: OBJECTIVE
  To evaluate the totally endovascular techniques for treating complex pararenal aortic aneurysms after open repair of abdominal aortic aneurysm.
  
  
  METHODS
  This retrospective study involved 34 men (mean age 74 years) with pararenal aortic aneurysms (22 pseudoaneurysms and 12 para-anastomotic aneurysms) that developed a median 11 years (range 4-22) after the primary surgical reconstruction. The median infrarenal neck length was 2 mm (range 0-9). Total endovascular aneurysm repair (EVAR) included the use of fenestrated (f-EVAR; n=17), branched (b-EVAR; n=11), combined f-EVAR/b-EVAR (n=1), and chimney (ch-EVAR; n=4) grafts and the "sandwich" technique (n=1). The primary outcome was aneurysm shrinkage >5 mm at latest follow-up. Secondary outcomes were target vessel patency, 30-day mortality, late survival, absence of type I and III endoleak, clinical success, and reintervention rate.
  
  
  RESULTS
  Technical success was 97% (n=33/34), while clinical success was achieved in 32 (94%) patients. The 30-day mortality was 3% (n=1/34). Mean follow-up was 23.2±16.6 months. One patient was lost to follow-up, and 1 patient underwent late open conversion for endograft infection. Six (18%) of the 33 surviving patients required a reintervention. Primary patency of the target aortic branches was 98% (109/111). Mean aneurysm diameter decreased from 64.1±10.2 to 56.7±16.9 mm (p<0.001) at latest follow-up. Midterm mortality was 12.1% (4/33). Estimated survival rates at 1 and 2 years were 93.9% and 90.9, respectively.
  
  
  CONCLUSIONS
  Use of f-EVAR, b-EVAR, and ch-EVAR allows effective treatment of postsurgical pararenal aneurysms based on a clear algorithm and patient selection, highlighting the complementary character of these less invasive approaches.
authors.affiliation: Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain cauzaza@hotmail.com.
authors.forename: Andrés
authors.initials: A
authors.lastname: Reyes
authors.affiliation: Department of Vascular Surgery, St Franziskus Hospital Münster and Clinic for Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany.
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Donas
authors.affiliation: Department of Surgery, Gennimatas Hospital, Aristotle University of Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Pitoulias
authors.affiliation: Department of Vascular Surgery, St Franziskus Hospital Münster and Clinic for Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Austermann
authors.affiliation: Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain.
authors.forename: Claudio
authors.initials: C
authors.lastname: Gandarias
authors.affiliation: Department of Vascular Surgery, St Franziskus Hospital Münster and Clinic for Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Torsello
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / 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; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency
keywords: aneurysm; branched stent-graft; chimney technique; fenestrated stent-graft; pararenal abdominal aorta; reintervention; sandwich technique; target vessel patency