Letter to the Editor The Chimney Technique with the Ovation Trivascular Device: New Kid on the Block!
Dear Editor, We read with great interest the article by Schiro et al.,1 reporting on their experience with the chimney technique for treatment of juxtarenal abdominal aortic aneurysms (AAA) in a series of 9 patients.1 Of these, the last case describes the chimney technique with the OvationTM Abdominal Stent Graft System (TriVascular, Santa Rosa, CA), introducing a novel modality that, according to our opinion, deserves further attention. This particular device
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Q1 Fig. 1. ---. Sources of financial support: None. Competitive relationships: None. Ann Vasc Surg 2014; -: 1–2 http://dx.doi.org/10.1016/j.avsg.2013.12.004 Ó 2014 Elsevier Inc. All rights reserved. Published online: --,-
56 57 58 59 60 61 62 63 64 comprises a proximal stent segment with integral anchors 65 for suprarenal fixation, an aortic body stent graft free from 66 nitinol skeleton, and 2 inflatable (with biocompatible fill 67 polymer) sealing rings (Fig. 1). 68 Apart from additional fixation, these rings also provide sufficient apposition to irregularities of calcification and 69 thrombus of the surface of the lumen, conforming also 70 to reverse-tapered necks.2 Interestingly, these specific 71 configuration and consequent adaptation capacity of the 72 inflatable rings to challenging neck anatomies have been 73 recently recruited to achieve complete sealing against a 74 remodeleddwith an Amplatz Vascular PlugdAAA neck 75 3 surface. 1 76 Schiro et al. report for the first time in the literature the 77 successful combination of the Ovation device with a single 78 renal chimney graft, reporting sufficient graft patency and 79 absence of migration and endoleaks during a 12-month follow-up period. Because the presence and size of gutters 80 between the chimney and aortic endografts remain the 81 main concern to compromise the early or late results of 82 this technique,4,5 it seems logical to assume, based on the 83 aforementioned features, that the Ovation’s inflatable 84 rings may better embrace the chimney grafts, thus pro85 viding better sealing and elimination of the gutters in the 86 proximal zone. According to our opinion, this suggestion 87 should alarm the interventionalists for further clinical 88 research toward this option, because the latter could mark89 edly improve (if not revolutionize) the chimney technique. 90 1 Efstratios Georgakarakos Q2 91 2 George Trellopoulos 2 92 Dimitrios Pelekas 93 Nikolaos Schoretsanitis1 94 George S. Georgiadis1 95 Chris V. Ioannou3 1 Department of Vascular Surgery, ‘‘Democritus’’ University of 96 Thrace, University Hospital of Alexandroupolis, 97 Alexandroupolis, Greece 98 2 First Surgical Clinic, General Hospital ‘‘G. Papanikolaou’’ 99 Exohi, Thessaloniki, Greece 100 3 Vascular Surgery Department, University of Crete Medical 101 School, Heraklion, Crete, Greece 102 E-mail:
[email protected] 103 104 105 REFERENCES 106 1. Schiro A, Antoniou GA, Ormesher O, Pichel AC, 107 Farquharson F, Serracino-Inglott F. The chimney technique 108 in endovascular aortic aneurysm repair: late ruptures after 109 successful single renal chimney stent grafts. Ann Vasc Surg 110 2013;27:835e43. 1
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Annals of Vascular Surgery
2. Moulakakis KG, Dalainas I, Kakisis J, Giannakopoulos TG, Liapis CD. Current knowledge on EVAR with the ultra-low profile Ovation Abdominal Stent-graft System. J Cardiovasc Surg (Torino) 2012;53:427e32. 3. Gandini R, Pampana E, Stefanini M, Spano S, Martinelli F, Citraro D, Simonetti G. Neck remodeling using the amplatzer vascular plug to facilitate endovascular repair of a contained abdominal aortic rupture. J Endovasc Ther 2013;20:20e5.
4. Ohrlander T, Sonesson B, Ivancev K, Resch T, Dias N, Malina M. The chimney graft: a technique for preserving or rescuing aortic branch vessels in stent-graft sealing zones. J Endovasc Ther 2008;15:427e32. 5. de Bruin JL, Yeung KK, Niepoth WW, Lely RJ, Cheung Q, de Vries A, Blankensteijn JD. Geometric study of various chimney graft configurations in an in vitro juxtarenal aneurysm model. J Endovasc Ther 2013;20:184e90.
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