My Escape Through Chimney

Background: Open Repair (OR) remains the “gold standard” for treatment of AAAs and Juxtarenal Aneurysms (JAAA), although there is an increased morbidity and mortality rate, longer operating time, and higher need for transfusions. Endovascular repair (EVAR) offers an alternative as it obviates the need for extensive surgical dissection. Fenestrated EVAR (f-EVAR) devices are used in JAAA to overcome the insufficient neck length resulting in inadequate sealing of standard endografts. Chimney-graft technique EVAR (Ch-EVAR) has been employed to preserve the visceral aortic branches, deploying a stent parallel to the aortic endograft allowing the sealing in a healthier aortic zone. A recent review of the Ch-EVAR showed promising results in terms of morbidity, mortality, and durability at 6 and 12 months follow-up. Method(s): We present a unique case of a juxtarenal AAA (J-IAAA) with contained leak in the presence of an indwelling aortic stent with disintegration and kinkage of stent successfully treated with Ch-EVAR. Result(s): Patient was successfully treated with EVAR and bilateral renal artery chimney-grafts (Ch-EVAR). Conclusion(s): Ch-EVAR shows is valid and viable treatment as well as bail out option for challenging cases of JAAA, where a custom-made device is either not available or not amenable to deployment due to difficult access.

 

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Artikel online veröffentlicht:
11. Mai 2021