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

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.

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