title: A Double Nellix and Chimney Covered Stents: Challenging Treatment of Pararenal Aortic Aneurysm.
abstract: A 77-year-old male patient presented with a symptomatic, 66-mm pararenal aortic aneurysm. The patient was classified as unsuitable for open surgery due to significant comorbidities. Fenestrated or branched endografts were contraindicated due to the poor iliac access (6 mm diameter). A double Nellix with chimney endovascular aneurysm sealing (ChEVAS) technique was selected to exclude the pararenal aortic aneurysm and to preserve renal arteries and the superior mesenteric artery. Technical preplanning considered the ideal proximal landing zone to be close to the origin of the almost occluded celiac trunk and the distal common iliac arteries as the ideal distal landing zone. The total length of the aorta to cover was estimated as >180 mm, requiring 2 aortic EVAS systems, bilaterally overlapped. Technical success was achieved, and the patient was discharged on postoperative day 8 in good general condition. Successful aneurysm exclusion and target vessel patency without endoleak or stent-graft kinking or migration were confirmed at angio-computed tomography at 6 months.
authors.affiliation: 1 Vascular and Endovascular Surgery Department, Sant'Andrea Hospital, University of Rome-"La Sapienza," Rome, Italy.
authors.forename: Nazzareno
authors.initials: N
authors.lastname: Stella
authors.affiliation: 1 Vascular and Endovascular Surgery Department, Sant'Andrea Hospital, University of Rome-"La Sapienza," Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Ficarelli
authors.affiliation: 1 Vascular and Endovascular Surgery Department, Sant'Andrea Hospital, University of Rome-"La Sapienza," Rome, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Dito
authors.affiliation: 2 Anesthesiology Department, Sant'Andrea Hospital, University of Rome-"La Sapienza," Rome, Italy.
authors.forename: Domitilla
authors.initials: D
authors.lastname: Brancadoro
authors.affiliation: 3 Interventional Radiology Department, Sant'Andrea Hospital, University of Rome-"La Sapienza," Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Rossi
authors.affiliation: 1 Vascular and Endovascular Surgery Department, Sant'Andrea Hospital, University of Rome-"La Sapienza," Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Taurino
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000295:instrumentation*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome
keywords: EVAS; aortic aneurysm; chimney technique; totally percutaneous approach