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Chimney-Graft bei komplexen Aortenaneurysmen

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Chimney grafts for complex abdominal aortic aneurysms

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Zusammenfassung

Ziel

Evaluierung der Literatur der Chimney-Graft- (CG-)Technik zur Behandlung von komplexen abdominellen Aortenaneurysmen (AAA). In der vorliegenden Übersicht wurden Studien eingeschlossen, wenn während der endovaskulären Prozedur von komplexen AAAs die Revaskularisation von viszeralen Ästen der Aorta mit der CG-Technik durchgeführt wurde.

Resultate

Fünf Publikationen mit einer Gesamtzahl von 94 Patienten erfüllten die Einschlusskriterien. In 78,7% der Fälle fand die CG-Prozedur Anwendung bei der Behandlung von primären pararenalen oder juxtarenalen AAAs. In 19,2% der Fälle kam die CG-Technik bei an der Anastomose gelegenen Pseudoaneurysmen nach vorausgegangener offener Operation oder bei Endoleaks nach endovaskulärer Behandlung zum Einsatz. Zwei (2,1%) Patienten wurden wegen einer atheromatösen Verschlusskrankheit der Aorta operiert. Bei 16 (17%) Patienten kam die CG-Technik wegen dringlicher Operationsindikationen zum Einsatz. Insgesamt wurden 148 (1,57 pro Patient) viszerale Äste mit der CG-Technik behandelt (124 [83,8%] Nierenarterien, 21 [14,2%] A. mesenterica superior (AMS); 3 [2%] Truncus coeliacus (TC)). Der primäre technische Erfolg lag bei 96,8%. Frühe TYP-I-Endoleaks wurden bei 11% der Patienten beobachtet. Die Mortalität in den ersten 30 postoperativen Tagen betrug 5,3% (5,1% bei elektiven Eingriffen und 6,3% bei dringlichen- bzw. Notfallindikationen). Die Offenheitsrate des CG während der Nachuntersuchungen (durchschnittlich 9,9 Monate) lag bei 97,3%. Eine postoperative Verschlechterung der Nierenfunktion zeigte sich in 16% der Fälle. Zu kardialen Komplikationen kam es bei 7,4% und zum Apoplex bei 3,2%.

Schlussfolgerung

Die frühen Ergebnisse der CG-Technik zeigen die Praktikabilität der Methode. Da aber Langzeitergebnisse fehlen, sollte diese Technik primär auf Bail-out-Situationen oder akute Fälle beschränkt bleiben. Für Patienten mit elektiven Eingriffen bleiben die fenestrierten Stentgrafts bzw. die konventionelle offene Operation die Methode der Wahl.

Abstract

Purpose

The aim of this article is to review the literature reporting the use of the chimney graft (CG) technique for the treatment of complex abdominal aortic aneurysms (AAA).

Methods

Studies were included in the present review if revascularization of visceral branches during endovascular treatment of complex AAAs was accomplished with the CG technique. Case reports and non-consecutive series with less than ten patients were excluded.

Results

A total of 5 publications with a total number of 94 patients fulfilled the inclusion criteria. The CG procedure was applied for the treatment of primary pararenal or juxtarenal AAAs in 78.7 % and for the repair of para-anastomotic pseudoaneurysms or endoleaks after prior open or endovascular repair in 19.2%. Of the patients 2 (2.1 %) were operated on for atheromatous aortic occlusive disease and 16 (17%) in an urgent setting. A total of 148 (average 1.57 per patient) visceral vessels were treated with CGs: 124 (83.8 %) renal arteries, 21 (14.2 %) superior mesenteric arteries (AMS) and 3 (2 %) celiac arteries (CT). Primary technical success was 96.8 % with an early type I endoleak rate of 11 %. The 30-day in-hospital mortality was 5.3 % (5.1 % and 6.3 % for elective and urgent cases, respectively) and CG patency during follow-up (mean 9.9 months) was 97.3 %. Postoperative renal function impairment occurred in 16 %, cardiac complications in 7.4 % and ischemic stroke in 3.2 % of patients.

Conclusions

Early results of the CG method demonstrate feasibility but due to the lack of long-term outcome data this technique should be currently limited to bail-out procedures or acute situations. For elective cases, fenestrated stent grafting or open repair remain the treatments of choice.

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Interessenkonflikt

Prof. Dr. E. Verhoeven erhielt Studien-, Reisekostenunterstützungen und Honorare für Vorträge von den Firmen Cook, W.L. Gore, Siemens und Atrium.

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Authors and Affiliations

  1. Klinik für Gefäßchirurgie, vaskuläre und endovaskuläre Chirurgie, Klinikum Nürnberg Süd, Breslauer Str. 201, 90471, Nürnberg, Deutschland

    E.L.G. Verhoeven, A. Katsargyris, B. Ritter & K. Oikonomou

  2. Klinik für interventionelle Radiologie, Klinikum Nürnberg Süd, Nürnberg, Deutschland

    W. Ritter

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  1. E.L.G. Verhoeven
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  2. A. Katsargyris
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  3. B. Ritter
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  4. K. Oikonomou
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  5. W. Ritter
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Correspondence to E.L.G. Verhoeven.

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Verhoeven, E., Katsargyris, A., Ritter, B. et al. Chimney-Graft bei komplexen Aortenaneurysmen. Gefässchirurgie 17, 640–643 (2012). https://doi.org/10.1007/s00772-012-1026-3

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