Publication Date
6-1-2019
Journal
The Texas Heart Institute Journal
DOI
10.14503/THIJ-17-6520
PMID
31708700
Publication Date(s)
June 2019
Language
English
PMCID
PMC6827479
PubMedCentral® Posted Date
June 2019
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Aortic aneurysm, abdominal/pathology; blood vessel prosthesis implantation/instrumentation/methods; endoleak/etiology/prevention & control/therapy; endovascular procedures/instrumentation/methods; prosthesis design; stents; surgical stapling/instrumentation; treatment outcome
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Abstract
Juxtarenal abdominal aortic aneurysms (AAAs) are difficult to treat because they often have little or no proximal aortic neck. Patients with this complex anatomy are not usually candidates for an endovascular aneurysm repair (EVAR). Chimney-graft EVAR has been introduced, but type Ia endoleak is a typical risk. We have begun using EndoAnchors to determine whether this risk can be reduced. From July 2013 through July 2014, we used the chimney-graft EVAR technique in 5 patients whose juxtarenal AAAs had a short or no proximal aortic neck. During the procedure, we implanted EndoAnchors as needed. Postprocedurally, at 30 days, and through end of follow-up (duration, 11-18 mo), all patients had patent endografts without type Ia endoleak (our primary endpoint), visceral stent-graft thrombosis, or renal complications. One patient who received 4 chimney grafts had a postprocedural type II endoleak, which was treated with embolization. We found it feasible to use EndoAnchors with the chimney-graft technique to prevent type Ia endoleaks in the treatment of juxtarenal AAAs. Further studies are needed to validate this adjunctive technique and to determine its durability.