Background
This article describes a chimney technique (ChEVAR) to preserve the patency of the
inferior mesenteric artery (IMA) in a patient with abdominal aortic aneurysm (AAA)
and bilateral internal iliac artery obstruction. In addition, a review of the literature
is performed.
Case report
This article describes a male in his 70s with multiple comorbidities and a 5.6 cm
infrarenal aortic aneurysm. CT scan showed bilateral iliac internal artery obstruction
with compensatory hypertrophy of lumbar arteries along with a 6 mm inferior mesenteric
artery. We planned a staged treatment: embolization of lumbar arteries to prevent
type 2 endoleak as a first step, followed two months later by standard EVAR with chimney
graft to maintain patency of IMA. The postoperative course was uneventful. The endograft
was widely patent on CT scan at his 6-month follow-up visit.
Conclusions
ChEVAR to preserve the patency of IMA is a feasible and valid technique that could
be considered in the case of bilateral hypogastric obstruction.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Annals of Vascular SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Ischemic complications after endovascular abdominal aortic aneurysm repair.J Vasc Surg. 2004; 40 (discussion 709-10): 703-709
- Colonic ischemia complicating open vs endovascular abdominal aortic aneurysm repair.J Vasc Surg. 2008; 48: 272-277
- The mesenteric circulation. Anatomy and physiology.Surg Clin North Am. 1997; 77: 289-306
- The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm.J Vasc Surg. 2018; 67: 2-77.e2
- Novel indication for chimney graft placement in the inferior mesenteric artery during endovascular repair of abdominal aortic aneurysm..J Endovasc Ther. 2014; 21 (5): 548-552
- Periscope graft to extend distal landing zone in ruptured thoracoabdominal aneurysms with short distal necks..J Vasc Surg. 2010; 51 (7): 1293-1296
- Chimney and periscope grafts observed over 2 years after their use of revascularize 169 renovisceral branches in 77 patients with complex aortic aneurysms.J Endovasc Ther. 2013; (9): 597-605
- A novel chimney approach for management of horseshoe kidney during EVAR..EJVES Short Rep. 2016; 33 (8): 16-19
- Snorkel technique for inferior mesenteric artery during endovascular repair of abdominal aortic aneurysm..Vasc Endovascular Surg. 2018; 52 (6): 233-236
- Use of covered chimney stents for pararenal aortic pathologies is safe and feasible with excellent patency and low incidence of endoleaks.J Vasc Surg. 2012; 55: 659-665
- CT angiography at 24 months demonstrates durability of EVAR with the use of chimney grafts for pararenal aortic pathologies.J Endovasc Ther. 2013; 20: 1-6
- Should patients with challenging anatomy be offered endovascular aneurysm repair?.J Vasc Surg. 2003; 38: 990-996
Article Info
Publication History
Published online: March 03, 2022
Accepted:
January 26,
2022
Received:
March 10,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
