The “chimney” technique offers the cheapest and most ready-to-use option for urgent repair of aneurysm in the renal and superior mesenteric arteries, according to Martin Malina, Malmoe University Hospital, Sweden, and dedicated grafts should be designed and manufactured for this purpose.
Endovascular repair is usually considered unsuitable for urgent repair of juxtarenal aneurysm, as a tailor-made fenestrated or branched graft would seem to be required. But juxtarenal aneurysm is challenging for open repair too, Malina said, and, as an added challenge, patients with juxtarenal aneurysm are often not fit for open surgery.
The chimney technique should therefore be the preferred solution, said Malina.
He described the variations of the technique, and showed recent cases from his clinic. “We use this technique roughly once per month in Malmoe right now,” he said.
“They are potentially applicable to all aortic branches,” Malina added. “I think they provide an interesting alternative to branched and fenestrated grafts in emergency cases where you don’t have time to make a tailor-made device. You can do them quickly, they are off-the-shelf device. And being off-the-shelf devices they have another important feature: they are much cheaper than the tailor-made devices.
“But we still do need dedicated, composite chimney grafts that will be better designed for this particular purpose.”
Malina was addressing delegates at the CACVS congress in Paris, January 2009.