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Collected World Experience of the Snorkel/Chimney Endovascular Technique in the Treatment of Complex Aortic Aneurysms: The PERICLES Registry
Jason T Lee*1, Konstantinos Donas*2, Mario Lachat*3, Giovanni Torsello*2, Frank J. Veith4
1Stanford University Medical Center, Stanford, CA;2Muenster University Hospital, Muenster, Germany;3University Hospital Zurich, Zurich, Switzerland;4New York University-Langone Medical Center, New York, NY

OBJECTIVE(S):
Endovascular aneurysm repair (EVAR) has largely replaced open surgery worldwide for anatomically suitable aortic aneurysms. Lack of availability of fenestrated devices and off the shelf solutions have encouraged an alternative strategy utilizing parallel, or snokel/chimney grafts (ch-EVAR). We sought to examine the collected worldwide experience with use of ch-EVAR for complex aneurysm treatment.
METHODS:
Clinical and radiographic information was retrospectively reviewed and analyzed on 517 patients treated by ch-EVAR from 2008-2014 by pre-arranged defined and documented protocols.
RESULTS:
119 patients in US centers and 398 in European centers were treated during the study period. US centers preferentially used Zenith stent-grafts (54.2%) and European centers Endurant stent-grafts (62.2%). Overall 898 chimney grafts (49% vs 51% balloon-expandable vs self-expandable covered stents) were placed into 692 renal arteries, 156 SMAs, and 50 celiacs. At a mean followup of 17.1 months (1-70 months), primary patency was 94%, with secondary patency of 95.3%. Type Ia endoleak was present in 5.7% with secondary intervention rates of 37.9%. Overall survival of patients in this high-risk cohort for open repair at latest follow-up was 79%.
CONCLUSIONS:
This global experience is the largest series in the literature of ch-EVAR and demonstrates comparable outcomes to published branched/fenestrated devices and is independent of the type of abdominal device or selected chimney graft, suggesting it’s broad applicability to most surgeons. These results support ch-EVAR as a valid off-the-shelf alternative in the treatment of complex EVAR and give impetus for the standardization of the technique in the future.


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