Purpose: To demonstrate the feasibility of emergent endovascular repair of a ruptured pararenal aneurysm using chimney grafts and the Nellix endovascular aneurysm sealing (EVAS) system to reduce the potential for endoleak from the gutters around the chimney grafts. Case Report: A 74-year-old patient presented with a ruptured pararenal aneurysm. Because of anatomical considerations after previous aortic surgery, conventional endovascular aneurysm repair was deemed impossible. It was decided to exclude the aneurysm with a Nellix EVAS system in conjunction with two chimneys to the renal arteries, even though this was outside the instructions for use of the device. Active bleeding was stopped directly after positioning the chimneys and filling the endobags with polymer. Completion angiography showed aneurysm exclusion and patent renal arteries. Renal function remained stable, and the patient was discharged at the third postoperative day. At 6 months, duplex ultrasound and computed tomography showed patent stents and chimneys and no evidence of endoleak. Conclusion: Using chimney grafts in combination with the Nellix endoprosthesis in a ruptured pararenal aneurysm is feasible. However, more robust data on both chimney-EVAS and EVAS in ruptured cases are required.
DillavouEDMulukSCMakarounMS. A decade of change in abdominal aortic aneurysm repair in the United States: have we improved outcomes equally between men and women?J Vasc Surg. 2006;43:230–238.
2.
VeithFJ. The management of ruptured abdominal aortic aneurysms. J Cardiovasc Surg (Torino). 2009;50(5):573–574.
3.
HoornwegLLStorm-VerslootMNUbbinkDT. Meta analysis on mortality of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2008;35:558–570.
4.
ThomasDMHultenEAEllisST. Open versus endovascular repair of abdominal aortic aneurysm in the elective and emergent setting in a pooled population of 37,781 patients: a systematic review and meta-analysis. ISRN Cardiol. 2014;149243. doi:10.1155/2014/149243.
5.
SpeicherPJBarbasASMureebeL. Open versus endovascular repair of ruptured abdominal aortic aneurysms. Ann Vasc Surg. 2014;28:1249–1257.
6.
DavenportDLO’KeeffeSDMinionDJ. Thirty-day NSQIP database outcomes of open versus endoluminal repair of ruptured abdominal aortic aneurysms. J Vasc Surg. 2010;51:305–309.
7.
ReimerinkJJHoornwegLLVahlAC; Amsterdam Acute Aneurysm Trial Collaborators. Endovascular repair versus open repair of ruptured abdominal aortic aneurysms: a multicenter randomized controlled trial. Ann Surg. 2013;258:248–256.
8.
KatsargyrisAOikonomouKKlonarisC. Comparison of outcomes with open, fenestrated, and chimney graft repair of juxtarenal aneurysms: are we ready for a paradigm shift?J Endovasc Ther. 2013;20:159–169.
9.
KrievinsDKHoldenASavlovskisJ. EVAR using the Nellix sac-anchoring endoprosthesis: treatment of favourable and adverse anatomy. Eur J Vasc Endovasc Surg. 2011;42:38–46.
10.
BöcklerDReijnenMMKrievinsD. Use of the Nellix EVAS system to treat post-EVAR complications and to treat challenging infrarenal necks. J Cardiovasc Surg (Torino). 2014;55:601–612.
11.
DijkstraMLLardenoyeJWvan OostayenJA. Endovascular aneurysm sealing for juxtarenal aneurysm using the Nellix device and chimney covered stents. J Endovasc Ther. 2014;21:541–547.
12.
MalkawiAHde BruinJLLoftusIM. Treatment of a juxtarenal aneurysm with the Nellix endovascular aneurysm sealing system and chimney stent. J Endovasc Ther. 2014;21:538–540.
13.
NiepothWWde BruinJLLelyRL. In vitro feasibility of a sac-sealing endoprosthesis in a double chimney graft configuration for juxtarenal aneurysm. J Endovasc Ther. 2014;21:529–537.
