Single-Center Study Supports Total Endovascular Treatment of Juxtarenal Aortic Aneurysms in Octogenarians
January 20, 2016—Online in the Journal of Vascular Surgery (JVS), Diogo Silveira, MD, et al published findings for the late 3-year performance of total endovascular treatment of juxtarenal aortic aneurysms in octogenarians using the chimney/snorkel technique.
Between January 2009 and December 2014, endovascular aortic aneurysm repair was performed using the chimney/snorkel technique at one center in 35 high-risk octogenarian patients with juxtarenal aortic aneurysms who were unfit for open repair. Twenty-five patients (71.4%) were asymptomatic, and 10 patients were treated in an urgent care setting. The median follow-up was 36 months (range, 1–69 months). The primary endpoint was the survival rate.
As summarized in JVS, the investigators reported that the technical success rate was 100%. A single chimney graft placement was performed in 22 patients (62.9%), double chimneys were performed in 10 patients (28.6%), and triple chimneys were performed in three (8.5%) patients. Overall, 51 renovisceral vessels (22 right renal arteries, 23 left renal arteries, and six superior mesenteric arteries) were involved.
The 30-day mortality rate was 2.9% (n = 1). Early morbidity was 14.3%, predominantly due to access-related complications. Major adverse events were observed in 5.7% (n = 2) of the present cohort. No early reinterventions for endoleaks were registered. The midterm reintervention rate was 12.1% due to type Ib endoleak (n = 1), type II endoleak (n = 1), and high-grade chimney graft stenosis (n = 2). Estimated survival was 91.9% at 1 year and 72.8% at 3 years. Freedom from reintervention at 1 and 3 years was 94% and 91%, respectively.
Juxtarenal aortic aneurysm treatment with endovascular aortic aneurysm repair using the chimney/snorkel technique in octogenarians is associated with low perioperative mortality and morbidity, as well as acceptable midterm survival and secondary procedures, concluded the investigators in JVS.