Korean Circ J.  2013 Jun;43(6):416-421. 10.4070/kcj.2013.43.6.416.

A Case of Abdominal Aortic Aneurysm with Short Angulated Proximal Neck Treated with the Chimney Graft Technique

• Lee S
• Ko YG
• Choi D
• Lee DY

• KMID: 2224904
• DOI: http://doi.org/10.4070/kcj.2013.43.6.416

Abstract

Endovascular aneurysm repair (EVAR) using stent grafts has shown to be an effective alternative to surgical repair in treating an abdominal aortic aneurysm (AAA). EVAR is associated with shorter hospital stays, less blood loss, shorter operating times, and lower early morbidity and mortality compared to open surgical repair, although EVAR required a higher reintervention rate during a longer follow-up period. However, short or severely an angulated infrarenal proximal aortic neck is considered unsuitable for EVAR. The chimney graft technique is a modified procedure based on the deployment of a covered or bare-metal stent parallel to the main aortic endograft within the aneurysm, thereby creating a conduit that runs outside the aortic main endograft to preserve flow to the aortic branches. In this case report, we present a 78-year-old patient with an AAA with a short and severely angulated proximal neck who was successfully treated by EVAR using the chimney graft technique.

Keyword

Aortic aneurysm, abdominal; Endovascular techniques

MeSH Terms

Aneurysm
Aortic Aneurysm, Abdominal
Endovascular Procedures
Humans
Length of Stay
Neck
Stents
Transplants

Figure

• 

  Fig. 1 Baseline CT images of abdominal aortic aneurysm. A: three dimensional reconstruction image of the abdominal aortic aneurysm. B: axial view of abdominal aortic aneurysm at right renal artery (upper) and left renal artery level (middle) with a maximum diameter of 63 mm (below). C: coronal view of the infrarenal abdominal aortic artery, the black arrow indicates the length of the aortic neck to the right renal artery orifice which was 16 mm, and the white arrow indicates the left renal artery. The left renal artery orifice was adjacent to the aneurysm and there was practically no neck.

• 

  Fig. 2 Procedure steps of the chimney technique. A: insertion of an aortic extension stent graft (36×70 mm, Endurant, Medtronic, Santa Rosa, CA, USA) and a renal stent graft (6×50 mm, Viabahn, Gore, Flagshiff, AR, USA). B: the main body (36×20×166 mm, Endurant, Medtronic) was inserted at AAA in overlapping with the distal part of the aortic extension stent graft. C: adjuvant balloon dilation was performed by kissing balloon technique using a 46 mm Reliant balloon (Medtronic) for aorta stent graft and a 6×40 mm balloon for the left renal stent graft. D: additional balloon dilation of bifurcated stent graft was performed.

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  Fig. 3 Angiographic result after endovascular aneurysm repair using the Chimney graft technique. A: final angiogram showing no significant endoleak and patent left renal artery. B: stent at main body and left artery. C: flow through the left renal artery.

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  Fig. 4 A CT scan taken 4 days after the procedure showing complete exclusion of the abdominal aortic aneurysm sac and patent Viabahn stent graft deployed in the left renal artery. A: 3 dimensional reconstruction view. B: axial view of the aortic stent. White arrows indicate the stent graft in the left renal artery.

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