Supatcha Prasertcharoensuk
Nationality
Thailand
Current Position
Associated Professor / Head of vascular unit
Organization
Faculty of medicine, Khon Kaen university
Abdominal Aorta & Aortic iliac Session

Topic: Chimney EVAR as a rescue re-intervention technique

Abstract

Standard EndoVascular Aneurysm Repair (EVAR) was performed as a procedure of choice in an infrarenal abdominal aortic aneurysm patient even in non favorable anatomy. In severe angulated neck concomitant with borderline neck length cases need to extend stent graft landing in a visceral aorta, chimney EVAR is a rescue procedure in some cases and re-chimney again when degenerate disease or graft fatigue occurs. Choice of stent graft type must be selected  in order to conform anatomy and prevent later graft failure.Standard EndoVascular Aneurysm Repair (EVAR) was performed as a procedure of choice in an infrarenal abdominal aortic aneurysm patient even in non favorable anatomy. In severe angulated neck concomitant with borderline neck length cases need to extend stent graft landing in a visceral aorta, chimney EVAR is a rescue procedure in some cases and re-chimney again when degenerate disease or graft fatigue occurs. Choice of stent graft type must be selected  in order to conform anatomy and prevent later graft failure. These are two cases demonstrating chimney EVAR as a rescue procedure. an 87 year old woman presented with abdominal pain after standard EVAR and chimney EVAR due to endoleak type Ia from angulated neck and borderline neck length with the endologix AFX endovascular AAA system 2 years ago. Computed Tomography Aortogram (CTA) reveals endoleak type 3 at angulated part between 2 VelaTM proximal endograft. We performed re-chimney renal artery and SMA stent to extend the landing zone to above celiac level. Another case is an 86 year old man present with right leg monoparesis after treating AAA with the Nellix® EndoVascular Aneurysm Sealing System for 5 years. CTA shows endoleak type Ia and Ib with rupture aneurysm at right side of aorta, we decided to perform chimney with both iliac limb extend in visceral aorta and iliac limb extension. These two patients went fine with resolve of endoleak. Chimney EVAR technique has an impressive outcome as a rescue procedure in some cases that vascular surgeons should familiar with the step even though other complex EVAR such as Custom made device  (CMD) or Physician-Modified Endovascular Graft have a better in long term outcome but not every anatomy that will fit to these technique.

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