Eren İSMAİLOĞLU, Secil EKER, Halil BOZKAYA, Emrah OĞUZ, Celal CİNAR, Mustafa PARILDAR, Hakan POSACIOĞLU, İsmail ORAN

Kısa Boyunlu Jukstarenal Aort Anevrizmalarının Greft Stent ile Tedavisinde Chimney Tekniğinin Kullanımı: Retrospektif Bir Çalışma

Giriş: Endovasküler tedavi yöntemlerinden biri olan chimney tekniğinin sonuçlarının yüz güldürücü olması, ucuz olması, fenestre stentlere ve hibrid yönteme göre avantajlarının bulunması bu yöntemin daha fazla tercih edilme sebebidir. Amaç: Kısa boyunlu jukstarenal aort anevrizmalarının greft stent ile endovasküler tedavisinde chimney tekniğinin sonuçlarının değerlendirilmesidir. Gereç-Yöntem: Çalışmaya 2008-2013 tarihleri arasında abdominal aort anevrizması nedeniyle girişimsel radyoloji bölümünde chimney tekniği uygulanarak endovasküler greft stent yöntemi ile tedavi edilen; preoperatif ve postoperatif bilgisayarlı tomografi anjiografi görüntüleri dijital radyoloji arşiv sisteminde kayıtlı olan jukstarenal aort anevrizmalı 17 hasta alındı. Hastaların preoperatif ve postoperatif dijital subtraksiyon anjiografi ve BTA görüntüleri retrospektif olarak değerlendirildi. Chimney tekniği kullanımının sonuçları tartışıldı. Bulgular: Çalışmaya alınan 17 hastanın yaş ortalaması 68.94±9.46’dır. Anevrizma etiyolojisinde 14 hastada ateroskleroz, 3 hastada ise vaskülit yer almaktaydı. 4 hastada operasyon öncesi anevrizma rüptürü mevcuttu. Hastaların anevrizma boyun uzunluğu ortalaması 3.02±2.8 mm (0-9 mm), operasyon sonrası takip süresi ortalaması 6.86±4.6 ay (1-16 ay) idi. Preoperatif ve postoperatif 6 ve 12. ay anevrizma çap ortalamaları arasında anlamlı fark bulundu (p<0.05). 17 hastaya planlanan toplam 28 chimney stent girişiminin 2’sinde chimney stentlerin yerleştirilmesi başarısızlıkla sonuçlandı (Başarı oranı %92.86). Başarılı olunan 15 hastanın 9’unda bilateral renal artere, 3’ünde sol renal artere, 2’sinde sağ renal artere, 1’inde SMA’ya chimney stent yerleştirildi. Takipte 3 hastada endoleak (2 hasta Tip IIA, 1 hasta Tip IA), 3 hastada toplam 4 arterde ise tromboz gelişti. Sonuç: Jusktarenal aort anevrizmalı bireylerin endovasküler tedavisinde chimney yönteminin kullanımı başarılı bir yöntemdir

Anahtar Kelimeler:

Jukstarenal aort anevrizması, EVAR, Chimney tekniği

Use of Chimney Technique in the Treatment of Short-Necked Juxtarenal Aortic Aneurysms with Graft Stent: A Retrospective Study

Introduction: Chimney technique is also cheaper than the other alternative treatment methods. Additionally, this technique has more advantages compared to fenestrated stent and hybrid procedure. Objective: The aim of the current study was to evaluate the results of chimney technique with endovascular treatment in short neck juxtarenal aortic aneurysms. Methods: The study included 17 patients with juxtarenal abdominal aorta aneurysm, treated with endovascular stent greft by using chimney technique at interventional radiology department between January 2008 and April 2013. Patients underwent preoperative and postoperative digital subtraction angiography (DSA) and computed tomography angiography (CTA), and the images were recorded in digital radiology archive. Preoperative and postoperative DSA and CTA images of patients were retrospectively evaluated. The results of the chimney technique were discussed. Findings: The mean age of 17 patients (all men) was 68.94±9.46 years. Among the aneurysm etiologies, there were 14 patients with atherosclerosis and 3 patients with vasculitis. Four patients had preoperative aneurysm rupture. The average length of the aneurysm neck of patients was 3.02±2.8 mm (0-9 mm), and the average follow-up period after the operation was 6.86±4.60 (1-16 months). Technical failure occurred in 2 of 17 patients (Success rate; 92.86%). Chimney stent was placed in bilateral renal artery of 9 patients, in left renal artery of 3 patients, in right renal artery of 2 patients, and in SMA of 1 patient of 15 patients. Endoleak was demonstrated in 3 patients, while thrombosis was demonstrated in 3 patients on CTA. There was significant difference in mean aneurysm diameters in preoperative, postoperative 6. and 12. months (p<0.05). Conclusion: Chimney technique is a successful method in patients with juxtarenal aorta aneurysm treated with endovascular treatment.

Keywords:

Jukstarenal aorta aneurysm, EVAR, Chimney techique,

PDF

___

Wanhainen A, Verzini F, Van Herzeele I, ve ark. Editor’s choice - european society for vascular surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg. 2019;57:8–93.
Pua U, Tan K. Radiology of advanced EVAR techniques in complex abdominal aortic aneurysms. European radiology. 2012;22.2:387-397.
Tolenaar JL, Keulen JW, Trimarchi S, Muhs BE, Moll FL, Herwaarden JA. The chimney graft, a systematic review. Ann Vasc Surg. 2012;26(7):1030-1038.
Prapassaro T, Teraa M, Chinsakchai K, Hazenberg CEVB, Hunnangkul S, Moll FL, van Herwaarden JA. Mid-Term Outcomes of Chimney Endovascular Aortic Aneurysm Repair: A Systematic Review and Meta-analysis. Ann Vasc Surg. 2022;79:359-371.
Greenberg RK, Clair D, Srivastava S, Bhandari G, Turc A, Hampton J, et al. Should patients with challenging anatomy be offered endovascular aneurysm repair? J Vasc Surg. 2003;38:990-6.
Moulakakis K, Papapetrou A, Giannakopoulos T, Avgerinos D, Kakisis J, Brountzos EN, Christos D. The chimney graft technique for preserving renal arteries in stent-graft sealing zones. Vasa. 2012;41:295–300.
Günerhan Y, Işık M, Dereli Y, Tanyeli Ö, Kadıyoran C, Iyisoy MS, Görmüş N. Assessing volumetric changes in abdominal aortic aneurysms following endovascular repair. Cardiovascular Journal of Africa. 2021;32(4):182-187.
Numan F, Gülşen F, Arbatlı H,Cantaşdemir M, Solak S. Aort anevrizmalarının endovasküler tedavisinde yeni ufuklar. Türk Göğüs Kalp Damar Cer Dergisi. 2011;19Suppl 2:27-32.
Donas KP, Lee JT, Lachat M, ve ark. Collected world experience about the performance of the snorkel/chimney endovascular technique in the treatment of complex aortic pathologies: the PERICLES registry. Ann Surg 2015;262:546–53.
Banno H, Cochennec F, Marzelle J, et al. Comparison of fenestrated endovascular aneurysm repair and chimney graft techniques for pararenal aortic aneurysm. J Vasc Surg. 2014;60:31–9.
Jernigan EG, Tran NN, Quato K, Giangola G, Crroccio A, Conway AM. Outcomes of chimney/snorkel endovascular repair for symptomatic and ruptured abdominal aortic aneurysms. Journal of Vascular Surgery.2021;74.4:1117-1124.
Li Y, Hu Z, Bai C, ve ark. Fenestrated and chimney technique for juxtarenal aortic aneurysm: a systematic review and pooled data analysis. Sci Rep 2016;6:20497
XiaoHui M, Wei G, ZhongZhou H, ve ark. Endovascular repair with chimney technique for juxtarenal aortic aneurysm: a single center experience. Eur J Vasc Endovasc Surg. 2015;49:271–6.
Igari K, Kudo T, Toyofuku T, et al. The outcomes of endovascular aneurysm repair with the chimney technique for juxtarenal aortic aneurysms. Ann Thorac Cardiovasc Surg. 2016;22:174–80.
Caradu C, Morin J, Poirier M, ve ark. Monocentric evaluation of chimney versus fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysm. Ann Vasc Surg. 2017;40:28–38.
Morikage N, Mizoguchi T, Takeuchi Y, ve ark. Chimney endovascular aneurysm repair using endurant stent-grafts with bare balloon-expandable stents for patients with juxtarenal aortic aneurysms. J Endovasc Ther. 2019;26:350–8.
Coscas R, Kobeiter H, Desgranges P, Becquemin JP. Technical aspects, current indications, and results of chimney grafts for juxtarenal aortic aneurysms. J. Vasc Surg.2011;53(6):1520-1527.
Ukovich L, Biasion C, Nikolakopoulos K, Cera C, Mucelli PF, Adovasio R. Chimney technique in EVAR treatment of short aortic proximal necks: Preliminary experience. Italian Journal of Vascular and Endovascular Surgery.2012;19(3 Suppl 1):75-81.
Donas KP, Usai MV, Taneva GT, Criado FJ, Torsello GB, Kubilis P, Scali S, Veith FJ. Impact of aortic stent-graft oversizing on outcomes of the chimney endovascular technique based on a new analysis of the PERICLES Registry. Vascular, 2019,27(2): 175-180.
Donas KP, Criado FJ, Torsello G, Veith FJ, Minion DJ. PERICLES Registry Collaborators. Classification of chimney EVAR–related endoleaks: Insights from the PERICLES Registry. Journal of Endovascular Therapy. 2017;24(1):72-74.
Donas, K. P., Torsello, G. B., Piccoli, G., Pitoulias, G. A., Torsello, G. F., Bisdas, T., ... & Gasparini, D. The PROTAGORAS study to evaluate the performance of the Endurant stent graft for patients with pararenal pathologic processes treated by the chimney/snorkel endovascular technique. Journal of Vascular Surgery. 2016;63(1),1-7.
Bruen KJ, Feezor RJ, Daniels MJ, Beck AW, Lee WA. Endovascular chimney technique versus open repair of juxtarenal and suprarenal aneurysms. J Vasc Surg. 2011;53:895-905.
Touma J, Caradu C, Sylvestre R, Settembre N, Schneider F,Moia A, et al. Multicentre experience with the chimney technique for abdominal aortic aneurysms in French university hospitals. European Journal of Vascular and Endovascular Surgerg. 2020;59(5):776-784.