目的 对比烟囱EVAR（ch-EVAR）与开窗EVAR（f-EVAR）治疗肾旁腹主动脉瘤（PAAA）的中期疗效，探讨基于解剖特征的术式选择策略。 方法 回顾性分析2013年1月至2021年12月天津医科大学总医院收治的95例PAAA患者临床资料，其中ch-EVAR组52例，f-EVAR组43例。比较两组技术成功率、围手术期并发症及36个月随访结果。采用ROC曲线分析两组患者解剖参数（扭曲指数与计划重建分支数量）的分布特征。 结果 ch-EVAR组与f-EVAR组技术成功率分别为98.08%和97.67%（P > 0.05）。f-EVAR组计划重建内脏动脉数量多于ch-EVAR组［（2.19 ± 1.22）条 vs. （1.23 ± 0.58）条，P < 0.001）］。ROC曲线分析显示，两组扭曲指数的分布区分阈值为1.08（AUC = 0.925），重建分支数量阈值为1.5条（AUC = 0.726）。f-EVAR组术后即刻Ⅲ型内漏发生率高于ch-EVAR组（16.28% vs 0.00%，P = 0.003），但总体内漏发生率组间差异无统计学意义。平均随访（35.4 ± 24.2）个月，两组累积生存率、免于非PAAA相关死亡率及免于二次手术干预率差异均无统计学意义（P > 0.05）。 结论 ch-EVAR与f-EVAR治疗PAAA的中期疗效相当。基于本中心回顾性数据，对于扭曲指数< 1.08且需重建≥ 2支内脏动脉者，可倾向选择f-EVAR；对于扭曲指数> 1.08且仅需重建1支分支动脉的高龄患者，ch-EVAR是安全有效的手术方案。

Objective To compare the mid-term outcomes of chimney endovascular aneurysm repair （ch-EVAR） and fenestrated endovascular aneurysm repair （f-EVAR） in treating pararenal abdominal aortic aneurysm （PAAA）， and to explore the anatomical criteria for the selection of the procedure. Methods A retrospective analysis was carried out on the clinical data of 95 patients with PAAA who were treated at Tianjin Medical University General Hospital from January 2013 to December 2021. Among them， there were 52 patients in the ch-EVAR group and 43 in the f-EVAR group. The technical success rate， perioperative complications， and 36-month follow-up outcomes were compared between the two groups. Receiver operating characteristic （ROC） curve analysis was conducted to characterize the distribution of anatomical parameters， such as the tortuosity index and the number of planned reconstructed branches. Results The technical success rates were 98.08% in the ch-EVAR group and 97.67% in the f-EVAR group （P > 0.05）. The number of planned reconstructed visceral arteries was notably higher in the f-EVAR group compared to the ch-EVAR group （2.19 ± 1.22 vs. 1.23 ± 0.58， P < 0.001）. ROC curve analysis indicated a tortuosity index threshold of 1.08 （AUC = 0.925） and a reconstructed branch number threshold of 1.5 （AUC = 0.726） that could distinguish the two groups. The incidence of immediate type Ⅲ endoleak was greater in the f-EVAR group than in the ch-EVAR group （16.28% vs. 0.00%， P = 0.003）， while the overall endoleak rate did not show a significant difference between the groups. During a mean follow-up period of （35.4 ± 24.2） months， no significant differences were found in the cumulative survival rate， freedom from non-PAAA-related mortality， or freedom from secondary intervention between the two groups （P > 0.05）. Conclusions Ch-EVAR and f-EVAR exhibit comparable mid-term efficacy in the treatment of PAAA. According to the retrospective data from our center， f-EVAR might be the preferred choice for patients with a tortuosity index < 1.08 who need to reconstruct ≥ 2 visceral arteries. In contrast， ch-EVAR serves as a safe and effective surgical alternative for elderly patients with a tortuosity index > 1.08 who only require single-branch reconstruction.