What we have learned from in-vitro studies of the chimney endovascular technique for treatment of complex abdominal aortic aneurysms: A systematic review

Jorn P Meekel; Bich L Tran; Theodorus G van Schaik; Konstantinos P Donas; Gergana T Taneva; Vincent Jongkind; Kak K Yeung

doi:10.1177/17085381221095294

What we have learned from in-vitro studies of the chimney endovascular technique for treatment of complex abdominal aortic aneurysms: A systematic review

Vascular. 2023 Dec;31(6):1051-1060. doi: 10.1177/17085381221095294. Epub 2022 May 16.

Authors

Jorn P Meekel^{1

2

3}, Bich L Tran^{1

2}, Theodorus G van Schaik^{1

2

3}, Konstantinos P Donas⁴, Gergana T Taneva⁴, Vincent Jongkind^{1

2}, Kak K Yeung^{1

2}

Affiliations

¹ Department of Surgery, Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands.
² Department of Physiology, Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam UMC, Amsterdam, The Netherlands.
³ Department of Surgery, Zaans Medisch Centrum, Zaandam, The Netherlands.
⁴ Department of Vascular Surgery, Asklepios Clinic Langen, University of Frankfurt, Langen, Germany.

PMID: 35578179
DOI: 10.1177/17085381221095294

Abstract

Background: A considerable number of patients with abdominal aortic aneurysms (AAA) is not eligible for standard endovascular repair. These complex cases require alternative surgical approaches including the readily available chimney graft endovascular aneurysm repair (Ch-EVAR) or sealing (Ch-EVAS). The optimal configuration for Ch-EVAR or Ch-EVAS is important for success but not yet known.

Objective: The aim of the present study was to analyze current data of the outcomes of in-vitro chimney graft treatment in complex AAA.

Methods: A systematic review following PRISMA guidelines was conducted including studies reporting on gutter size, main graft compression, and chimney graft compression in in-vitro configurations.

Results: The search resulted in 285 articles. 11 studies considering 219 individual tests could be included. Gutter size was comparable between Ch-EVAR and Ch-EVAS configurations. In Ch-EVAR set-ups, the deployed BECG were Advanta V12, VIABAHN®, and BeGraft. One type of SECG was used: VIABAHN®. The four types of main grafts (MG) deployed were: Endurant™ I/II; EXCLUDER Conformable AAA Endoprosthesis and AAA Endoprosthesis, and AFX™ Endovascular AAA Delivery System. In the EVAS-configurations, the Nellix® EVAS system was deployed. In general, SECG presented smaller gutters with higher chimney graft compression. 30% main grafts oversizing seems to give the smallest gutters without high risk of infolding of MG. Oversizing, EndoAnchors, and secondary endobag filling (in Ch-EVAS) reduced gutter sizes. CG ballooning during the entire polymer injection in Ch-EVAS prevented CG compression.

Conclusion: In-vitro investigations provide insight in optimal Ch-EVAR and Ch-EVAS configurations for simulated complex AAA repair. The findings above might aid physicians in their planning to potential CG set-ups and can be used in future research to refine the most optimal configuration for chimney graft technique in complex AAA.

Keywords: EVAS; abdominal aortic aneurysms; chimney graft; compression; endovascular aneurysm repair; gutter; in-vitro; main graft.

Publication types

Systematic Review
Review

MeSH terms

Aortic Aneurysm, Abdominal* / diagnostic imaging
Aortic Aneurysm, Abdominal* / surgery
Blood Vessel Prosthesis Implantation* / adverse effects
Endovascular Aneurysm Repair
Endovascular Procedures* / adverse effects
Humans
Learning