Parallel endografting and chimney endovascular (PEACE) registry outcomes in emergency repair of complex abdominal aortic aneurysms
Karelis, Angelos Adam, Donald Piazza, Michele Tinelli, Giovanni Gallito, Enrico Matsagkas, Miltiadis Mees, Barend Mani, Kevin D'Oria, Mario Mansour, Wassim
Karelis, Angelos
Adam, Donald
Piazza, Michele
Tinelli, Giovanni
Gallito, Enrico
Matsagkas, Miltiadis
Mees, Barend
Mani, Kevin
D'Oria, Mario
Mansour, Wassim
Affiliation
Other Contributors
Publication date
2025-12-24
Subject
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
BACKGROUND: Chimney endovascular aneurysm repair (chEVAR) techniques have been described to manage a group of patients who are unsuitable for either open aortic aneurysm surgery or a variety of standard endovascular repair techniques. The aim of this study was to assess the long-term clinical outcomes of chEVAR in emergency settings for patients with abdominal aortic aneurysms that have complex morphology.
METHODS: This was a multicentre retrospective study that included all consecutive patients undergoing urgent chEVAR with at least one chimney/parallel graft up to June 2021. Outcomes that were captured included 30-day mortality, long-term overall survival, aneurysm-related mortality, chimney-related complications, and target vessel patency.
RESULTS: Some 118 patients (mean(s.d.) age of 77(8) years; 72.0% male) underwent urgent or emergency chEVAR, 78 (66.1%) due to aortic rupture. The mean(s.d.) number of chimneys used per patient was 1.6(0.7). Technical success was achieved in 90.6% of patients, with a 30-day mortality rate of 17.7%. The mean follow-up was 4(3) years. Estimated overall survival was 69 ± 5% at 3 years, 45 ± 6% at 5 years, and 32 ± 6% at 7 years. Freedom from aneurysm-related mortality was 58 ± 6% at 5 years and 53 ± 6% at 7 years. In patients surviving the perioperative 30-day interval, freedom from aneurysm-related mortality was 73 ± 6% at 5 years and 66 ± 7% at 7 years. Primary target vessel patency at 5 and 7 years was 87 ± 4%, with renal arteries most frequently affected. Late reinterventions occurred in 16.1% of patients, mostly for type Ia endoleaks (8 of 25 reinterventions (32%)) and type Ib endoleaks (5 of 25 reinterventions (20%)).
CONCLUSION: In this Parallel Endografting And Chimney Endovascular (PEACE) registry study, chEVAR was associated with a high rate of technical success and acceptable early outcomes, but, in the longer term, was associated with high rates of reintervention and mortality. It appears to represent a reasonable alternative technique for patients presenting as an emergency with complex aortic aneurysm morphology when standard open and endovascular techniques are not feasible.
Citation
Karelis A, Adam D, Piazza M, Tinelli G, Gallito E, Matsagkas M, Mees B, Mani K, D'Oria M, Mansour W, Cieri E, Kölbel T, Sonesson B, Dias NV; PEACE Contributors. Parallel Endografting And Chimney Endovascular (PEACE) registry outcomes in emergency repair of complex abdominal aortic aneurysms. Br J Surg. 2025 Dec 24;113(1):znaf278. doi: 10.1093/bjs/znaf278.
Type
Article