Objectives To compare early outcomes of endovascular repair of juxtarenal abdominal aortic aneurysms (JAAAs) using the chimney technique with fenestrated endovascular aneurysm repair (FEVAR) in anatomically-matched patients.
Methods Between January 2008 and December 2012, 37 patients underwent endovascular repair of juxtarenal abdominal aortic aneurysms with chimney stenting (Ch-EVAR) of 1 or 2 renal arteries. These were compared with 13 anatomically-matched patients that underwent fenestrated endovascular aneurysm repair (FEVAR) during the same time period. Primary end points were 30-day mortality, renal artery stent patency, and type I endoleak. Secondary end points included early complications, renal function, and length of stay (LOS).
Results Despite a higher coronary artery disease, chronic obstructive pulmonary disease and lower baseline renal function, 30-day mortality was identical with one death (7.7%) in FEVAR group. There was no death in Ch-EVAR group. Total LOS were significantly less for Ch-EVAR. Two patients (5.4%) in the chimney group had dialysis-dependent renal failure compared with the open group, in which there was no one dialysis-dependent renal failure. Renal function at 6 months demonstrated similar declines in the creatinine in the Ch-EVAR and FEVAR groups (111.3 ± 94.9 vs 134.7 ± 95.0 umol/L, P = 0.57). Primary patency at 6 and 12 months was 97.7% and 100%, respectively. There was twelve type I endoleak noted at 30 days, and 7 resolved by 6 months in Ch-EVAR group, compared with two noted at 30 days, and all resolved by 6 months in FEVAR group.
Conclusions Ch-EVAR and FEVAR for repair of juxtarenal aneurysms are viable alternatives to open repair. These two techniques have relatively good results, considering the anatomic limitations of the aortic neck. They appears to have similar mortality with less morbidity. However, long-term durability and stent patency remain to be determined.
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