TY - JOUR
T1 - Multicentre Experience with the Chimney Technique for Abdominal Aortic Aneurysms in French University Hospitals
AU - for the Association Universitaire pour la Recherche en Chirurgie (AURC) Collaborators
AU - Touma, Joseph
AU - Caradu, Caroline
AU - Sylvestre, Raphaelle
AU - Settembre, Nicla
AU - Schneider, Fabrice
AU - Moia, Alessia
AU - Ben Ahmed, Sabrina
AU - Lebas, Benoit
AU - Gaudric, Julien
AU - Alsac, Jean Marc
AU - Warein, Edouard
AU - Coscas, Raphaël
AU - Thaveau, Fabien
AU - Soler, Raphael
AU - Duprey, Ambroise
AU - Ammi, Myriam
AU - Desgranges, Pascal
AU - Ducasse, Eric
AU - Coggia, Marc
AU - Allaire, Eric
AU - Becquemin, Jean Pierre
AU - Cochennec, Frédéric
AU - Kobeiter, Hicham
AU - Goëau-Brissonnière, Olivier
AU - Malikov, Serguei
AU - Ricco, Jean Baptiste
AU - Della Schiava, Nellie
AU - Millon, Antoine
AU - Chaufour, Xavier
AU - Jayet, Jérémie
AU - Koskas, Fabien
AU - Julia, Pierre
AU - El Batti, Salma
AU - Chakfe, Nabil
AU - Bartoli, Michel
AU - Magnan, Pierre Edouard
AU - Piquet, Jean
AU - Rosset, Eugenio
N1 - Funding Information:
Raphael Coscas has been a consultant for Medtronic Inc., Gore Inc., Spectranetics Inc., and Bard Inc. and received research grants from Gore Inc. and Spectranetics Inc. Jean-Marc Alsac has been a consultant for Medtronic Inc. and Endologix Inc. No other authors disclosed any conflict of interest.
Funding Information:
Raphael Coscas has been a consultant for Medtronic Inc., Gore Inc., Spectranetics Inc., and Bard Inc. and received research grants from Gore Inc. and Spectranetics Inc. Jean-Marc Alsac has been a consultant for Medtronic Inc. and Endologix Inc. No other authors disclosed any conflict of interest.
Publisher Copyright:
© 2020 European Society for Vascular Surgery
PY - 2020/5
Y1 - 2020/5
N2 - Objective: The chimney technique (ChEVAR) allows for proximal landing zone extension for endovascular repair of complex aortic aneurysms. The aim of the present study was to assess ChEVAR national outcomes in French university hospital centres. Methods: All centres were contacted and entered data into a computerised online database on a voluntary basis. Clinical and radiological data were collected on all consecutive ChEVAR patients operated on in 14 centres between 2008 and 2016. Patients were deemed unfit for open repair. Factors associated with early (30 day or in hospital) mortality and type 1 endoleak (Type I EL) were calculated using multivariable analysis. Results: In total, 201 patients with 343 target vessels were treated. There were 94 juxtarenal (46.8%), 67 pararenal (33.3%), 10 Crawford type IV thoraco-abdominal (5%) aneurysms, and 30 (15.1%) proximal failures of prior repairs. The pre-operative diameter was 66.8 ± 16.7 mm and 28 (13.9%) ChEVAR were performed as an emergency, including six (2.9%) ruptures. There were 23 (11.7%) unplanned intra-operative procedures, mainly related to access issues. The rate of early deaths was 11.4% (n = 23). The elective mortality rate was 9.8% (n = 17). Nine patients (4.5%) presented with a stroke. The rate of early proximal Type I EL was 11.9%. Survival was 84.6%, 79.4%, 73.9%, 71.1% at 6, 12, 18, and 24 months, respectively. The primary patency of chimney stents was 97.4%, 96.7%, 95.2%, and 93.3% at 6, 12, 18, and 24 months, respectively. Performing unplanned intra-operative procedures (OR 3.7, 95% CI 1.3–10.9) was identified as the only independent predictor of post-operative death. A ChEVAR for juxtarenal aneurysm was independently associated with fewer post-operative Type I ELs (OR 0.17, 95% CI 0.05–0.58). Conclusion: In this large national ChEVAR series, early results were concerning. The reasons may lie in heterogeneous practices between centres and ChEVAR use outside of current recommendations regarding oversizing rates, endograft types, and sealing zones. Future research should focus on improvements in pre-operative planning and intra-operative technical aspects.
AB - Objective: The chimney technique (ChEVAR) allows for proximal landing zone extension for endovascular repair of complex aortic aneurysms. The aim of the present study was to assess ChEVAR national outcomes in French university hospital centres. Methods: All centres were contacted and entered data into a computerised online database on a voluntary basis. Clinical and radiological data were collected on all consecutive ChEVAR patients operated on in 14 centres between 2008 and 2016. Patients were deemed unfit for open repair. Factors associated with early (30 day or in hospital) mortality and type 1 endoleak (Type I EL) were calculated using multivariable analysis. Results: In total, 201 patients with 343 target vessels were treated. There were 94 juxtarenal (46.8%), 67 pararenal (33.3%), 10 Crawford type IV thoraco-abdominal (5%) aneurysms, and 30 (15.1%) proximal failures of prior repairs. The pre-operative diameter was 66.8 ± 16.7 mm and 28 (13.9%) ChEVAR were performed as an emergency, including six (2.9%) ruptures. There were 23 (11.7%) unplanned intra-operative procedures, mainly related to access issues. The rate of early deaths was 11.4% (n = 23). The elective mortality rate was 9.8% (n = 17). Nine patients (4.5%) presented with a stroke. The rate of early proximal Type I EL was 11.9%. Survival was 84.6%, 79.4%, 73.9%, 71.1% at 6, 12, 18, and 24 months, respectively. The primary patency of chimney stents was 97.4%, 96.7%, 95.2%, and 93.3% at 6, 12, 18, and 24 months, respectively. Performing unplanned intra-operative procedures (OR 3.7, 95% CI 1.3–10.9) was identified as the only independent predictor of post-operative death. A ChEVAR for juxtarenal aneurysm was independently associated with fewer post-operative Type I ELs (OR 0.17, 95% CI 0.05–0.58). Conclusion: In this large national ChEVAR series, early results were concerning. The reasons may lie in heterogeneous practices between centres and ChEVAR use outside of current recommendations regarding oversizing rates, endograft types, and sealing zones. Future research should focus on improvements in pre-operative planning and intra-operative technical aspects.
KW - Aneurysm
KW - Aortic
KW - Chimney
KW - Juxtarenal
KW - Multicentre
KW - Aortic Aneurysm, Abdominal/surgery
KW - Humans
KW - Hospitals, University
KW - Male
KW - Treatment Outcome
KW - Endovascular Procedures/methods
KW - Aged, 80 and over
KW - Female
KW - Aged
KW - Retrospective Studies
KW - France
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U2 - 10.1016/j.ejvs.2020.01.040
DO - 10.1016/j.ejvs.2020.01.040
M3 - Article
C2 - 32273159
AN - SCOPUS:85078743205
SN - 1078-5884
VL - 59
SP - 776
EP - 784
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
IS - 5
ER -