O-060 - COMBINING ENDOVASCULAR ANEURYSM SEALING WITH CHIMNEY GRAFTS - FIVE YEAR FOLLOW UP AFTER 47 PROCEDURES

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Zerwes S. (University Clinic Augsburg ~ Augsburg ~ Germany) , Kiessling J. (Sankt Gertrauden Hospital ~ Berlin ~ Germany) , Alexander S. (University Clinic Augsburg ~ Augsburg ~ Germany) , Liebetrau D. (University Clinic Augsburg ~ Augsburg ~ Germany) , Gosslau Y. (University Clinic Augsburg ~ Augsburg ~ Germany) , Bruijnen H. (University Clinic Augsburg ~ Augsburg ~ Germany) , Hyhlik-Dürr A. (University Clinic Augsburg ~ Augsburg ~ Germany)
Introduction:
While standard endovascular (abdominal) aneurysm repair (EVAR) is widely accepted as the main treatment modality for infrarenal abdominal aneurysms, the treatment of complex abdominal aortic aneurysms (AAA) remains a field of great controversy. The purpose of the present study was to evaluate longer-term results of a patient cohort treated with primary chimney endovascular aneurysm sealing (ChEVAS) for complex abdominal aortic aneurysms or secondary ChEVAS after failed endovascular aneurysm repair (EVAR)/EVAS.
Methods:
A single-center study was conducted of 47 consecutive patients (mean age 72±8 years, range 50-91; 38 men) treated with ChEVAS from February 2014 to November 2016 and followed through December 2021. Data were collected on patient characteristics, aneurysm morphology including thrombus ratio and number of chimney grafts implanted. The main outcome measures were all-cause mortality (ACM), aneurysm related mortality (ARM), occurrence of secondary complications (endoleak, migration, aneurysm growth and rupture) and conversion to open surgery, at 30 days and during follow-up, respectively. Data are presented as the median (IQR) and absolute range.
Results:
35 patients were treated with primary ChEVAS (=group I): Eight patients received a single target vessel, 22 a double target vessel, four a triple target vessel and one a quadruple target vessel chimney, respectively. 12 patients were treated with secondary ChEVAS after failed EVAR/EVAS (=group II): One patients received a single target vessel, six a double target vessel, four a triple target vessel and one a quadruple target vessel chimney, respectively. Technical success was 97% in group I and 92% in group II; 30-day mortality was 3% and 8%, respectively. The median proximal sealing zone length was 20.5 mm (IQR 16, 24; range 10-48) in group I and 26 mm (IQR 17.5, 30; range 8-45) in group II, respectively. During a median time of follow up of 60 months (range 0-88), ACM amounted to 60% in group I and 58% in group II; ARM was 29% and 17%, respectively. In group I 57% of patients developed an endoleak, 40% aneurysm growth and 40% had migration, resulting in open conversion in 20%. In group II 25% of patients developed an endoleak, 17% aneurysm growth and 17% had migration; resulting in two open conversions. Overall a secondary intervention was performed in 57% in group I and in 25% in group II, respectively. The occurrence of complications did not significantly differ between the two groups. Neither the number of implanted chimney grafts, nor the thrombus ratio significantly affected the occurrence of abovementioned mortality rates or complications, respectively.
Conclusion:
While initially delivering a high technical success rate, ChEVAS fails to provide acceptable longer-term results both in primary and secondary ChEVAS, resulting in high rates of complications, secondary interventions and open conversions.
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