Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2024; 21 (3): 163-272 ➤ Эндоваскулярное лечение субренальных и интерренальных аневризм брюшной аорты техникой «дымохода»

Endovascular treatment of subrenal and interrenal abdominal aortic aneurysms with the “chimney” technique

Authors: Bockeria L.A., Abdulgasanov R.A., Ivanov P.A., Abdulgasanova M.R.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2024-21-3-167-181

UDC: 616.136-007.64-089.819.5

Link: Clinical Physiology of Blood Circulaiton. 2024; 21 (3): 167-181

Quote as: Bockeria L.A., Abdulgasanov R.A., Ivanov P.A., Abdulgasanova M.R. Endovascular treatment of subrenal and interrenal abdominal aortic aneurysms with the “chimney” technique. Clinical Physiology of Circulation. 2024; 21 (3): 167–181 (in Russ.). DOI: 10.24022/1814-6910-2024-21-3-167-181

Keywords:  abdominal aortic aneurysm “chimney” technique subrenal aneurysm interrenal aneurysm abdominal aorta endovascular treatment

Received / Accepted:  02.08.2024 / 23.08.2024

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Abstract

Abdominal aortic aneurysm (AAA) occurs among the male population 45–54 years old in 1.3–1.5%, over 75–80 years old the frequency increases 10–12 times, and is 12.5–14%. In women, the prevalence of AAA ranges from 0 to 5.26.0%. The use of the chimney technique in endovascular repair (ChEVAR) of AAA was first used for emergency and urgent situations, treating ruptured AAAs, and is now successfully applied in elective procedures.

This review article examines the current literature from various clinics around the world on ChEVAR. The main focus is on clinical outcomes, technical considerations, and comparisons with other methods. New data on ChEVAR demonstrate favorable treatment results for juxtarenal and pararenal AAAs. Adequate endograft size, related to the length of the aneurysm neck, is crucial to prevent type 1a endoleaks. The chimney technique can be successfully used for treating juxtarenal and pararenal aortic aneurysms under certain anatomical conditions. However, the development of type 1a endoleaks after the procedure poses significant challenges, and further research is necessary to determine the safety and effectiveness of the method.

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****
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  17. Pitoulias G.A., Torsello G., Austermann M., Pitoulias A.G., Pipitone M.D., Fazzini S. et al. Outcomes of elective use of the chimney endovascular technique in pararenal aortic pathologic processes. J. Vasc. Surg. 2021; 73 (2): 433–442. DOI: 10.1016/j.jvs.2020.05.029
  18. Pitoulias G.A., Fazzini S., Donas K.P., Scali S.T., D’Oria M. , Torsello G. et al. Multicenter mid-term outcomes of the chimney technique in the elective treatment of degenerative pararenal aortic aneurysms. J. Endovasc. Ther. 2022; 29 (2): 226–239. DOI: 10.1177/15266028211047940
  19. Taneva G.T., Lee J.T., Tran K., Dalman R., Torsello G., Fazzini S. et al. Long-term chimney/snorkel endovascular aortic aneurysm repair experience for complex abdominal aortic pathologies within the PERICLES registry. J. Vasc. Surg. 2021; 73 (6): 1942–1949. DOI: 10.1016/j.jvs.2020.10.086
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  21. Taneva G.T., Fazzini S., Pipitone M.D., Karaolanis G., Torsello G., Bremer C. et al. Use of stainless-steel, balloon-expandable chimney grafts is durable though caution is required when lining angulated renal arteries. J. Endovasc. Ther. 2020; 27 (6): 902–909. DOI: 10.1177/1526602820948260
  22. Meekel J.P., Tran B.L., Van Schaik T.G., Donas K.P., Taneva G.T., Jongkind V., Yeung K.K. What we have learned from in-vitro studies of the chimney endovascular technique for treatment of complex abdominal aortic aneurysms: a systematic review. Vascular. 2023; 31 (6): 1051–1060. DOI: 10.1177/17085381221095294
  23. Taneva G.T., Donas K.P., Pitoulias G.A., Austermann M., Veith F.J., Torsello G. Cost-effectiveness analysis of chimney/snorkel versus fenestrated endovascular repair for high-risk patients with complex abdominal aortic pathologies. J. Cardiovasc. Surg. 2020; 61 (1): 18–23. DOI: 10.23736/S0021-9509.19.11146-9
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  25. Lopez S., Pillai L., Inkollu S. Ruptured juxtarenal abdominal aortic aneurysm managed with endosuture aneurysm repair. J. Vasc. Surg. Cases Innov. Tech. 2022; 8 (4): 861–864. DOI: 10.1016/j.jvscit.2022.11.002
  26. Fazzini S., Martinelli O., Torsello G., Austermann M., Pipitone M.D., Torsello G.F. et al. The PROTAGORAS 2.0 Study to identify sizing and planning predictors for optimal outcomes in abdominal chimney endovascular procedures. Eur. J. Vasc. Endovasc. Surg. 2021; 61 (4): 591–602. DOI: 10.1016/j.ejvs.2020.11.019
  27. Gallitto E., Faggioli G., Giordano J., Pini R., Mascoli C., Fenelli C. et al. Early and mid-term efficacy of fenestrated endograft in the treatment of juxta-renal aortic aneurysms. Ann. Vasc. Surg. 2020; 66: 132–141. DOI: 10.1016/j.avsg.2019.10.077
  28. Sveinsson M., Sonesson B., Kristmundsson T., Dias N., Resch T. Long-term outcomes after fenestrated endovascular aortic repair for juxtarenal ao rtic aneurysms. J. Vasc. Surg. 2022; 75 (4): 1164–1170. DOI: 10.1016/j.jvs.2021.11.050
  29. Taneva G.T., Criado F.J., Torsello G., Veith F., Scali S.T., Kubilis P. et al. Results of chimney endovascular aneurysm repair as used in the PERICLES Registry to treat patients with suprarenal aortic pathologies. J. Vasc. Surg. 2020; 71 (5): 1521–1527.e1. DOI: 10.1016/j.jvs.2019.08.228
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  31. Ullery B.W., Tran K., Itoga N.K., Dalman R.L., Lee J.T. Natural history of gutter-related type Ia endoleaks after snorkel/chimney endovascular aneurysm repair. J. Vasc. Surg. 2017; 65 (4): 981–990. DOI: 10.1016/j.jvs.2016.10.085
  32. Wang S.K., Gutwein A.R., Gupta A.K., Lemmon G.W., Sawchuk A.P., Motaganahalli R.L. et al. Institutional experience with the Zenith Fenestrated aortic stent graft. J. Vasc. Surg. 2018; 68 (2): 331–336. DOI: 10.1016/j.jvs.2017.11.063
  33. Nugroho N., Usai M.V., Fazzini S., Nugroho N.T. How to deal with the achilles heel of the chimney endovascular technique for complex aortic pathologies. JINASVS. 2020; 1 (2): i–ii. DOI: 10.36864/jinasvs.2020.2.001s
  34. Koleilat I., Nussenblatt B., Freidmann P., Lipsitz E., Indes J. Physician-modified endografts versus chimney/snorkel for ruptured and symptomatic juxtarenal and paravisceral aneurysms in the vascular quality initiative. Ann. Vasc. Surg. 2022; 82: 249–257. DOI: 10.1016/j.avsg.2021.10.062
  35. Gouveia E., Melo R., Fernández Prendes C., Caldeira D., Stana J., Rantner B. et al. Systematic review and meta-analysis of physician modified endografts for treatment of thoraco-abdominal and complex abdominal aortic aneurysms. Eur. J. Vasc. Endovasc. Surg. 2022; 64 (2–3): 188–199. DOI: 10.1016/j.ejvs.2022.04.015
  36. Torsello G., Usai M., Scali S., Kubilis P., Veith F., Markatis F. et al. Gender-related outcomes of chimney EVAR within the PERICLES registry. Vascular. 2018; 26 (6): 641–646. DOI: 10.1177/1708538118797448
  37. Fazzini S., Torsello G., Austermann M., Beropoulis E., Munaò R., Torsello G.F. Aortic endograft and bridging stent-graft remodeling after branched endovascular aortic repair. Vascular. 2021; 29 (6): 808–816. DOI: 10.1177/1708538120983698

About Authors

  • Leo A. Bockeria, Dr. Med. Sci., Professor, Academician of Russian Academy of Sciences, President; ORCID
  • Ramiz A. Abdulgasanov, Dr. Med. Sci., Chief Researcher for the Department of Surgery of Arterial Pathology; ORCID
  • Prokopiy A. Ivanov, Resident Physician; ORCID
  • Mekhriban R. Abdulgasanova, Applicant; ORCID

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