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Parallel graft techniques for urgent complex aortic diseases: Mid-term results of 12 cases
Luigi F Rinaldi1, Simona Chierico1, Giulia Marazzi1
1Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, 19001University of Pavia, Pavia, Italy.
Vascular
|May 13, 2020
Summary
Parallel grafting offers a feasible and safe endovascular repair for complex aortic aneurysms in urgent settings when custom grafts are unavailable. This technique successfully preserved visceral vessel patency, demonstrating its value in emergency aortic disease treatment.
Area of Science:
- Vascular Surgery
- Endovascular Repair
- Aortic Aneurysm Treatment
Background:
- Open repair for thoraco-abdominal and para-renal aortic aneurysms carries high morbidity and mortality, especially in urgent cases.
- While fenestrated/branched endografts are options, custom devices are often unavailable in emergencies, and standard devices are debated for complex anatomy.
- Parallel grafting using covered stents to maintain visceral vessel patency is a valuable urgent repair option, though durability concerns exist.
Purpose of the Study:
- To review the outcomes of complex aortic diseases treated with parallel grafting in emergent/urgent settings.
- To evaluate the feasibility and safety of the chimney and/or periscope technique for thoraco-abdominal and para-thoraco-abdominal aortic aneurysms.
- To assess the long-term outcomes and complications of parallel grafting in emergency aortic repair.
Main Methods:
- Retrospective review of consecutive endovascular aortic repairs for thoraco-abdominal and para-thoraco-abdominal aneurysms performed in urgency/emergency from 2016 to June 2019.
- Recording of clinical records, operative technique, primary technical success, and long-term outcomes.
- Follow-up by computed tomography angiography at three months and annually thereafter.
Main Results:
- Twenty patients with para-thoraco-abdominal (12) or thoraco-abdominal (8) aneurysms were treated using chimney/periscope techniques.
- Primary technical success was 100%, with one perioperative death and one late death from unrelated causes.
- All 37 stented visceral vessels remained patent over a median 22-month follow-up, with a 5% re-intervention rate for a type IB endoleak.
Conclusions:
- Parallel grafting is a feasible and safe option for urgent/emergent treatment of complex thoraco-abdominal and para-thoraco-abdominal aortic aneurysms.
- This technique should be considered when fenestrated and branched endografts are not viable or available.
- The study demonstrates the durability and safety of parallel grafting in emergency aortic repair.
