title: Chimney technique in combination with a sac-anchoring endograft for juxtarenal aortic aneurysms: technical aspects and early results.
abstract: Juxtarenal aortic aneurysms (JAAs) pose clinical challenges for vascular specialists. Chimney endovascular sealing (Ch-EVAS) might be an ideal endovascular solution in the treatment of JAAs. We present technical aspects and early clinical results of a multicenter experience with Ch-EVAS.
  
  
  
  This was a retrospective, multicenter study. Between November 2014 and March 2016, 16 patients underwent elective endovascular repair of JAAs with Ch-EVAS of 1 or 2 renal and/or superior mesenteric artery vessels. Essential technical steps, early complications, chimney stent patency, gutter formation, type IA endoleak, 30-day outcome, renal function, and neck characteristics were the endpoints.
  
  
  
  There were 26 chimney stents implanted with 100% technical success. The intraoperative death and 30 day mortality was 0%. Secondary interventions were required in 3 patients each due to type IA endoleak, limb occlusion and brachial dissection. The latter patient presented with renal chimney stent occlusion and required hemodialysis. One patient was known to have a pulmonary malignancy and left-sided carotid stenosis and sustained a left hemispheric stroke after the endovascular procedure. The preoperative median aortic neck length was 3 mm, after Ch-EVAS the median seal length between endobags and the aortic neck was 25 mm. No further significant changes in neck morphology were found at the one-month follow-up.
  
  
  
  Ch-EVAS is an off-the-shelf solution to treat JAAs with high technical success. Longer-term follow-up with a substantial number of patients can answer the question of whether Ch-EVAS is a sustainable technique that is preferred over open surgery or fenestrated endovascular aneurysm repair.
authors.affiliation: Department of Vascular Surgery, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands - s.overeem@antoniusziekenhuis.nl.
authors.forename: Maarten K
authors.initials: MK
authors.lastname: Dinkelman
authors.forename: Simon P
authors.initials: SP
authors.lastname: Overeem
authors.forename: Dittmar
authors.initials: D
authors.lastname: Bockler
authors.forename: Jean P
authors.initials: JP
authors.lastname: DE Vries
authors.forename: Jan M
authors.initials: JM
authors.lastname: Heyligers
mesh_terms: D015901:Angiography, Digital Subtraction; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005858:Germany; D006801:Humans; D009426:Netherlands; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome