title: Extended use of endovascular aneurysm sealing: Chimneys for juxtarenal aneurysms.
abstract: Hostile infrarenal aortic neck anatomy presents a challenge for the endovascular treatment of abdominal aortic aneurysm. Open surgical repair has been seen as the gold standard treatment for juxtarenal abdominal aortic aneurysm; however, endovascular techniques are now becoming more prevalent, particularly in patients deemed high risk for morbidity and mortality with open repair. The morphology of an aneurysm is a determinant of long-term outcomes, and short aneurysm necks are associated with poorer outcomes and a higher rate of secondary reinterventions. Parallel grafts have been used in combination with endovascular aneurysm repair to elongate the sealing zone into the paravisceral segment of the aorta. This technique is associated with a risk of proximal Type I endoleak due to "guttering." This risk may be decreased when parallel grafts are used in combination with endovascular aneurysm sealing and, as such, this technique may represent an alternative to current techniques for the treatment of juxtarenal abdominal aortic aneurysm, such as the use of conventional bifurcated grafts (with or without parallel grafts) and fenestrated endovascular stent grafts.
authors.affiliation: St George's Vascular Institute, St George's Hospital, Blackshaw Road, London SW17 0QT, UK. Electronic address: kstenson@doctors.org.uk.
authors.forename: K M
authors.initials: KM
authors.lastname: Stenson
authors.affiliation: St George's Vascular Institute, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
authors.forename: J L
authors.initials: JL
authors.lastname: De Bruin
authors.affiliation: St George's Vascular Institute, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
authors.forename: P J E
authors.initials: PJ
authors.lastname: Holt
authors.affiliation: St George's Vascular Institute, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
authors.forename: I M
authors.initials: IM
authors.lastname: Loftus
authors.affiliation: St George's Vascular Institute, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
mesh_terms: 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; D057867:Endoleak / Q000209:etiology / Q000517:prevention & control; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D011474:Prosthesis Design; D012042:Registries; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome