Outcome Of Chimney Technique In Patients With Pararenal Aneurysm With Mural Aortic Thrombus

• Published in: Hellenic Journal of Vascular and Endovascular Surgery 2023-11, Vol.5 (1)
• Main Authors: Fittipaldi, Alessandra, Castellana, Federica Maria, Pipitò, Narayana, Squillaci, Domenico, Benedetto, Filippo
• Format: Article
• Language: English
• ISSN: 2732-7175; 2732-7167
• DOI: 10.59037/3mwb5q04

Introduction and objective Chimney technique (ChEVAR) can be used to treat patients with urgent pararenal aortic aneurysm unfit for open surgery and not suitable for fenestrated endograft due to production time. Since almost one in five patients undergo a reintervention within three years, features associated with higher risk of complications need to be investigated in order to tailor the follow-up schedule. The aim of our study was to assess the impact of mural thrombus in the pararenal aorta on perioperative and follow-up complications after Chimney Technique. Methods All consecutive patients undergoing ChEVAR at our center from 2016 to 2022 were included in a retrospective study. Collected variables included number of target vessels, stent graft size, presence and severity of mural thrombus in pararenal aorta, which was evaluated on pre-operative computed tomography angiography and reported according to SVS reporting standards. Outcomes included peri-operative and follow-up complications such as endoleaks, chimney stent complications. Results 27 patients underwent ChEVAR for pararenal abdominal aneurysm instead 4 patients underwent ChEVAR for a type 1A endoleak after previous endovascular repair. Complications were the following: type 1A endoleak in 4 cases (13%), chimney stent complications in 7 cases (23%), renal function worsening during follow-up in 8 cases (26%). Decline of the eGFR during the follow up was moderate in 6 patients (19%), severe in 1 patient (3%). No one of our patients needed renal replacement therapy. Overall survival was 90% at two years. Patients with severe mural thrombus showed lower freedom from chimney-related complications (28% vs 59% at two years, p=0.023). No correlations have been found between number of target vessel and post-operative complications. Conclusions Our results show that the presence of severe pararenal aortic mural thrombus is associated with lower freedom from chimney related complications in patients treated by means of ChEVAR for pararenal abdominal aneurysm.