Use of Chimney Technique in the Treatment of Short-Necked Juxtarenal Aortic Aneurysms with Graft Stent: A Retrospective Study

Year 2023, Volume: 3 Issue: 1, 51 - 57, 12.04.2023

Eren İsmailoğlu , Secil Eker , Halil Bozkaya , Emrah Oğuz , Celal Cinar , Mustafa Parıldar , Hakan Posacıoğlu , İsmail Oran

https://doi.org/10.58252/artukluder.1234090

Abstract

Introduction: Chimney technique is also cheaper than the other alternative treatment methods. Additionally, this technique has more advantages compared to fenestrated stent and hybrid procedure.
Objective: The aim of the current study was to evaluate the results of chimney technique with endovascular treatment in short neck juxtarenal aortic aneurysms.
Methods: The study included 17 patients with juxtarenal abdominal aorta aneurysm, treated with endovascular stent greft by using chimney technique at interventional radiology department between January 2008 and April 2013. Patients underwent preoperative and postoperative digital subtraction angiography (DSA) and computed tomography angiography (CTA), and the images were recorded in digital radiology archive. Preoperative and postoperative DSA and CTA images of patients were retrospectively evaluated. The results of the chimney technique were discussed.
Findings: The mean age of 17 patients (all men) was 68.94±9.46 years. Among the aneurysm etiologies, there were 14 patients with atherosclerosis and 3 patients with vasculitis. Four patients had preoperative aneurysm rupture. The average length of the aneurysm neck of patients was 3.02±2.8 mm (0-9 mm), and the average follow-up period after the operation was 6.86±4.60 (1-16 months). Technical failure occurred in 2 of 17 patients (Success rate; 92.86%). Chimney stent was placed in bilateral renal artery of 9 patients, in left renal artery of 3 patients, in right renal artery of 2 patients, and in SMA of 1 patient of 15 patients. Endoleak was demonstrated in 3 patients, while thrombosis was demonstrated in 3 patients on CTA. There was significant difference in mean aneurysm diameters in preoperative, postoperative 6. and 12. months (p<0.05).
Conclusion: Chimney technique is a successful method in patients with juxtarenal aorta aneurysm treated with endovascular treatment.

Keywords

Jukstarenal aorta aneurysm, EVAR, Chimney techique

Kısa Boyunlu Jukstarenal Aort Anevrizmalarının Greft Stent ile Tedavisinde Chimney Tekniğinin Kullanımı: Retrospektif Bir Çalışma

Abstract

Giriş: Endovasküler tedavi yöntemlerinden biri olan chimney tekniğinin sonuçlarının yüz güldürücü olması, ucuz olması, fenestre stentlere ve hibrid yönteme göre avantajlarının bulunması bu yöntemin daha fazla tercih edilme sebebidir.
Amaç: Kısa boyunlu jukstarenal aort anevrizmalarının greft stent ile endovasküler tedavisinde chimney tekniğinin sonuçlarının değerlendirilmesidir.
Gereç-Yöntem: Çalışmaya 2008-2013 tarihleri arasında abdominal aort anevrizması nedeniyle girişimsel radyoloji bölümünde chimney tekniği uygulanarak endovasküler greft stent yöntemi ile tedavi edilen; preoperatif ve postoperatif bilgisayarlı tomografi anjiografi görüntüleri dijital radyoloji arşiv sisteminde kayıtlı olan jukstarenal aort anevrizmalı 17 hasta alındı. Hastaların preoperatif ve postoperatif dijital subtraksiyon anjiografi ve BTA görüntüleri retrospektif olarak değerlendirildi. Chimney tekniği kullanımının sonuçları tartışıldı.
Bulgular: Çalışmaya alınan 17 hastanın yaş ortalaması 68.94±9.46’dır. Anevrizma etiyolojisinde 14 hastada ateroskleroz, 3 hastada ise vaskülit yer almaktaydı. 4 hastada operasyon öncesi anevrizma rüptürü mevcuttu. Hastaların anevrizma boyun uzunluğu ortalaması 3.02±2.8 mm (0-9 mm), operasyon sonrası takip süresi ortalaması 6.86±4.6 ay (1-16 ay) idi. Preoperatif ve postoperatif 6 ve 12. ay anevrizma çap ortalamaları arasında anlamlı fark bulundu (p<0.05). 17 hastaya planlanan toplam 28 chimney stent girişiminin 2’sinde chimney stentlerin yerleştirilmesi başarısızlıkla sonuçlandı (Başarı oranı %92.86). Başarılı olunan 15 hastanın 9’unda bilateral renal artere, 3’ünde sol renal artere, 2’sinde sağ renal artere, 1’inde SMA’ya chimney stent yerleştirildi. Takipte 3 hastada endoleak (2 hasta Tip IIA, 1 hasta Tip IA), 3 hastada toplam 4 arterde ise tromboz gelişti.
Sonuç: Jusktarenal aort anevrizmalı bireylerin endovasküler tedavisinde chimney yönteminin kullanımı başarılı bir yöntemdir

Keywords

Jukstarenal aort anevrizması, EVAR, Chimney tekniği

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