Two-year results of chimney grafts show excellent stent-graft patency and stable/shrinking aneurysms


Two-year results of chimney grafts show
excellent stent-graft patency and
stable/shrinking aneurysms

Journal of Endovascular Therapy reports that High-risk patients benefit from less invasive procedures. A stent-grafting technique for aortic aneurysms is now showing promise for such patients. Chimney stent-grafts bring blood to aortic branch vessels that are covered by standard aortic stent-grafts during endovascular aneurysm repair (EVAR). This study provides some of the longest term results available for this procedure.
According to a study published in this journal, high-risk patients with pararenal aortic pathologies were treated between January 2008 and December 2011 at two European vascular and cardiovascular centers with advanced experience in the chimney graft technique. Of the 124 patients treated at these centers, 40 completed computed tomographic angiography (CTA) follow-up at 24 months after the procedure and were the subject of this study.
Expansion of the aorta, the largest artery in the body, brings the risk of rupture, which can cause severe pain, hemorrhage, and death if not immediately treated. A less invasive method of treating these aortic aneurysms involves placing a flexible covered tube known as a stent-graft inside the aorta to exclude the dilated segment from the blood flow, thereby reducing the risk of rupture. However, when important branch vessels are involved in the aneurysm, covering them can lead to serious problems with major organs, such as the kidneys and intestines. A treatment to address this problem involves placing a chimney graft, a covered stent, between the aortic endograft and the aortic wall. The chimney graft begins in the undiseased aorta and runs parallel to the aortic stent-graft, ending at the opening of a covered branch vessel, delivering blood to the vessel and the organ it supplies.
So far, only short-term results have been available regarding the success of this technique. While those results have been good, more information is needed before declaring this novel technique a success. The current study provides midterm results, following patients who underwent the procedure at least 2 years earlier.
Patients in this study had CTA imaging to determine the stability of the chimney stents. At 2 years after treatment, significant shrinkage or stable aneurysm diameter was seen in 90% of the cases. There were no aneurysm ruptures in follow-up
An accompanying commentary welcomes this news, calling it the most significant contribution of midterm results after chimney aortic repair … to date. The authors point out that the 40 patients treated at the first center have now successfully passed a mean time of more than 2-1/2 years since their procedure.
Full text of the article, CT Angiography at 24 Months Demonstrates Durability of EVAR With the Use of Chimney Grafts for Pararenal Aortic Pathologies and commentary article, Journal of Endovascular Therapy, Vol. 20, No. 1, 2013, are available at (PR)

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