Long-term chimney/snorkel EVAR experience for complex abdominal aortic pathologies within the PERICLES Registry. Journal of vascular surgery Taneva, G. T., Lee, J. T., Tran, K. n., Dalman, R. n., Torsello, G. n., Fazzini, S. n., Veith, F. J., Donas, K. P. 2020


Early and short-term efficacy of the snorkel/chimney technique (ch-EVAR) have been previously reported. However, long-term ch-EVAR performance, vessel patency, and patient survival remain unknown. Our study aimed to evaluate the late outcomes and to identify possible predictors for failure within the PERICLES registry.Clinical and radiographic data from patients receiving ch-EVAR between 2008-2014 in the PERICLES registry were updated with extension of the follow-up. Regression models were used to evaluate relevant anatomic and operative characteristics as factors influencing late results focusing on patients with at least 30 months of follow-up (mean 46.6 months; range 30-120 months).517 patients from the initial PERICLES registry were included in this analysis, from which mean follow-up was updated from previously 17.1 to 28.2 months (range, 1-120 months). All-cause mortality at latest follow-up was 25.5% (n=132), with an estimated patient survival of 87.6%, 74.4% and 66.1% at one, three and five years, respectively. A sub-group of 244 patients with 387 chimney grafts placed (335 renal, 42 SMAs, 10 celiac arteries) and follow-up of at least 30 months was used to analyze specific anatomic and device predictors of adverse events. In the sub-group, the technical success was 88.9%, while primary patency was 94%, 92.8%, 92%, and 90.5% at 2.5 years, 3 years, 4 years and 5 years respectively. Mean aneurysm sack regression was 7.8±11.4 mm,p<.0001. Chimney graft occlusion occurred in 24 target vessels(6.2%). Late open conversion was required in 5 patients for endograft infection(n=2), persistent T1a endoleak (n=2) and endotension (n=1), The absence of infrarenal neck (OR 2.86 [1.32-6.19], p=.007) was significantly associated with long-term device-related complications. Sealing zone diameter > 30mm was significantly associated with persistent/late type Ia endoleak (T1a EL)(OR 4.86 [1.42-16.59], p=.012).The present analysis of the PERICLES registry provides the missing long-term experience on the ch-EVAR technique showing favorable results with more than half of the patients surviving for more than 5 years and chimney graft branch vessels patency of 92%. The absence of infrarenal neck and treatment with sealing zone diameter >30mm were the main anatomical long-term limits of the technique demanding adequate preoperative planning and indication.

View details for DOI 10.1016/j.jvs.2020.10.086

View details for PubMedID 33259893