Vladimir Gavrilovic MD, Abstract Co-Author: Nothing to Disclose

Gianluca Piccoli MD, Presenter: Nothing to Disclose

Massimo Sponza, Abstract Co-Author: Nothing to Disclose

Alessandro Vit, Abstract Co-Author: Nothing to Disclose

Massimo Bazzocchi MD, Abstract Co-Author: Nothing to Disclose

Daniele Gasparini, Abstract Co-Author: Nothing to Disclose

To evaluate feasibility, safety and efficacy of Chimney-EVAR (Ch-EVAR) technique in patient with hostile proximal neck for standard EVAR.

From March 2009 until December 2013, 43 patients considered at high surgical risk underwent Ch-EVAR. Balloon-expandable or self-expandable stent-graft were implanted in the renal arteries, of which 10 bilaterally and 33 unilaterally. In all 43 patients 6-15 ml of fibrin glue were injected into the sac using a 5F catheter to obtain complete thrombosis and reduce the risk of late type-2 leak. The results of the Ch-EVAR procedure were evaluated at 1, 6 and 12 months and annually by CT angiography (CTA), and clinically (serum creatinine) at 24h, 1 month and 6 months and annually thereafter.

Ch-EVAR technique was feasible in all patients. Final angiogram proved the exclusion of the sac, and no type 1 endoleaks. Mean follow-up was 16 (1-38) months. Average serum creatinine before the procedure and at 1, 6 and 12 months follow-up (FU) was respectively 1.4, 1.9, 1.5 and 1.3 ml/dl. In five patients creatinine increased significantly within 24h post-procedure, and a CT angiogram showed renal stent thrombosis; three patients were revascularized successfully whereas the two were considered not revascularizable. Eight patients died during the follow-up (non aortic death); all other patient were alive in stable clinical condition at FU.

According to our preliminary experience, Ch-EVAR technique is feasible, safe, and effective to treat patients with hostile proximal neck in AAA. Acute stent thrombosis is quite rare but possible complication, dayli serum creatinine monitoring is mandatory in the postoperative period.

Ch-EVAR technique is good option for non-surgical, and AAA patients with hostile proximal neck. It is complex and high skills demanded procedure. The most frequent complication is acute stent thrombosis.

Gavrilovic, V, Piccoli, G, Sponza, M, Vit, A, Bazzocchi, M, Gasparini, D, Endovascular Renal Chimney Stent-graft Technique in Patient with Hostile Proximal Neck: Technique and Acute/Mid-term Results.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14017317.html