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Expanding the Indications for use of EVAR and TEVAR Grafts with Parallel Stent Grafts: Early Experience with Snorkels and Chimneys
Mathew Wooster, MD, Murray Shames, MD, Martin Back, MD, Bruce Zweibel, Paul Armstrong, DO, Karl Illig, MD, Neil Moudgill, MD, Peter Nelson, MD, Brad Johnson, MD.
University of South Florida, Tampa, FL, USA.

Objective: While fenestrated and branched devices for parvisceral and thoracic aneurysms are available worldwide, limited US availability has perpetuated widespread utilization of adjunctive techniques for the endovascular treatment of these aneurysms. The objective of the study is to report on the technical feasibility and short-term durability of parallel grafts for paravisceral and thoracoabdominal aneurysms
Methods: We performed a retrospective review of a prospectively collected EVAR database, including all patients that underwent a parallel stent procedure.
End points included: 1) number vessels snorkeled 2) endoleaks 3) morbidity and mortality and 4) snorkel graft patency.
Results: Thirty-eight patients (84% male, mean 77.8 years of age) were treated for primary aneurysms (27), para-anastomotic aneurysms (5) following prior open repair, and endoleaks (8) following prior endovascular repair. Sixty-nine visceral vessels were preserved. Bilateral femoral arteries were accessed as well as the left upper extremity via either percutaneous (n=4) brachial, open brachial (n=4), or open axillary (n=20) artery exposure. The mean length of surgery was 252 minutes with average of ICU stay of 3.5 days. There were eight endoleaks noted, six access site complications, two perioperative deaths, and three branch vessel stent occlusions. We have a mean follow up time of 198 days (Range 0-1215).
Vessels CannulatedNEndoleakN
Unilateral Renal20Type I3
Bilateral Renal14Type II4
Bilateral Renal, SMA3Type III1
Bilateral Renal, SMA, Celiac3

Conclusion: Parallel stent graft repair for paravisceral aneurysms is feasible and has acceptable technical/clinical success and complication rates. Though long-term follow up is still needed, this technique fills the gap in endovascular options for poor open surgical candidates in whom fenestrated devices are not available.


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