Thorac Cardiovasc Surg 2017; 65(02): 112-119
DOI: 10.1055/s-0036-1571304
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Endovascular Repair of Paravisceral Aortic Aneurysms Combining Chimney Grafts and the Nellix Endovascular Aneurysm Sealing Technology (Four-Vessel ChEVAS)

Marwan Youssef
1  Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz—Mainz, Germany
,
Friedrich Dünschede
1  Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz—Mainz, Germany
,
Hazem El Beyrouti
1  Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz—Mainz, Germany
,
Ora Salem
1  Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz—Mainz, Germany
,
Christian-Friedrich Vahl
1  Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz—Mainz, Germany
,
Bernhard Dorweiler
1  Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz—Mainz, Germany
› Author Affiliations
Further Information

Publication History

23 August 2015

11 December 2015

Publication Date:
18 February 2016 (online)

Abstract

Background We demonstrate our initial experience and first results of the endovascular aneurysm sealing (EVAS) technology with chimney grafts for the treatment of paravisceral aneurysms.

Methods We present a consecutive series of seven patients with a mean age of 75 years who had been treated by four-vessel-chimney EVAS (ChEVAS) between May 2014 and May 2015. All patients were ASA grade ≥ III and were not eligible for fenestrated/branched endovascular aortic repair (fEVAR/brEVAR) due to urgency (n = 5) or anatomical constraints (n = 2).

Results Total 28 renovisceral target vessels were treated by balloon-expandable covered stents and 14 Nellix devices were used to seal the paravisceral aorta. Overall, 16 Nellix (Endologix Inc., Irvine, California, United States) devices and 65 covered stents were implanted with a technical success of 100%. Perioperatively, one patient with ruptured aneurysm died due to respiratory failure following splenic laceration/splenectomy (mortality = 14%) and in one patient, laceration of an axillary access vessel occurred. At a median follow-up of 6 months, all six surviving patients were well and no reinterventions were necessary. One chimney was found occluded without clinical sequelae resulting in a patency rate of 96%.

Conclusion Four-vessel ChEVAS may serve as alternative treatment option in highly selected cases of either acute paravisceral aortic pathology and/or situations, where the implantation of fEVAR/brEVAR is hampered by anatomical constraints. Further follow-up and a multicenter study are of course warranted to corroborate these initial results.