Endovascular Repair Of Ruptured Complex Aortic Aneurysms Using Chimney/Snorkel (Parallel) Grafts
Mark Fleming, MD, Lauren Benner Grimsley, MD MBA, Sam Tyagi, MD, Eric Endean, MD, Dong Lee, MDM, Tana Repella, MD PhD, Joseph Bobadilla, MD, David Minion, MD.
University of Kentucky, Lexington, KY, USA.
OBJECTIVES: There have been significant improvements in operative mortality in repair of infrarenal ruptured abdominal aortic aneurysms (rAAA) using endovascular techniques. Unfortunately, mortality has remained high for ruptured juxtarenal, pararenal, paravisceral, and thoracoabdominal aortic aneurysms given the lack of off-the-shelf devices. We aim to present our outcomes for ruptured endovascular aortic repair (rEVAR) using chimney/snorkel (Parallel) grafts in complex aneurysms (juxtarenal, pararenal, paravisceral, and thoracoabominal).
METHODS: This is single center retrospective review of all rAAA undergoing rEVAR using chimney/snorkel grafts for complex aneurysms from January 2010 to February 2022. Primary outcome was 30-day mortality. Secondary outcomes were chimney/snorkel graft patency, major complications.
RESULTS: Nineteen patients were identified from January 2010 to February 2022. Three patients (16%) had a single renal artery snorkel. Three patients (16%) had a 2-vessel parallel graft repair. Eight patients (42%) had a 3-vessel parallel graft repair. Five patients (26%) had a 4-vessel parallel graft repair. Median age of the patients was 68 years. 32% (5/19) of patients were female. Overall 30-day mortality was 16% (n=3). The 30-day mortality for female patients was 20% (1/5) and 14% (2/14) in males. In the survivors there were a total of 44 parallel grafts. Two of the 44 grafts in survivors thrombosed in late follow-up. Both were in the same patient at 682 days following the index procedure. One graft required a balloon angioplasty and stent for stenosis at the origin 73 days from initial surgery. No other grafts lost patency during follow-up.
CONCLUSIONS: These results are favorable to reports of open repair for rAAA. In addition, the mortality is similar to many reports of rEVAR for infrarenal ruptures. The use of parallel grafts in rEVAR for complex aortic aneurysms can be done with acceptable mortality and a low reintervention rate. 
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