The Journal of Practical Medicine >

2026 , Vol. 42 >Issue 12: 2128 - 2135

DOI: https://doi.org/10.3969/j.issn.1006-5725.2026.12.006

Oncology: Diagnosis, Treatment and Prevention

Mid-term outcomes and surgical strategy analysis of chimney EVAR and fenestrated EVAR in the treatment of pararenal abdominal aortic aneurysm

  • Xiaoxing ZHANG ,
  • Jingyao HE ,
  • Xiangchen DAI
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  • 1.Department of Vascular Surgery，General Hospital of Tianjin Medical University，Tianjin 300052，Tianjin，China
    2.Tianjin Key Laboratory of Precision Vascular Reconstruction and Organ Function Restoration，Tianjin 300052，Tianjin，China
    3.Tianjin Institute of General Surgery，Tianjin 300052，Tianjin，China

Received date: 2026-02-04

  Online published: 2026-06-30

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Abstract

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.

Key words： abdominal aortic aneurysm; endovascular aneurysm repair; chimney technique; fenestrated technique; tortuosity index

Cite this article

Xiaoxing ZHANG , Jingyao HE , Xiangchen DAI . Mid-term outcomes and surgical strategy analysis of chimney EVAR and fenestrated EVAR in the treatment of pararenal abdominal aortic aneurysm[J]. The Journal of Practical Medicine, 2026 , 42(12) : 2128 -2135 . DOI: 10.3969/j.issn.1006-5725.2026.12.006

References

[1] ISSELBACHER E M， PREVENTZA O， HAMILTON BLACK J R， et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease： A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines ［J］. Circulation， 2022， 146（24）： e334-e482.doi： 10.1161/cir.0000000000001106 .
[2] ANAGNOSTAKOS J， LAL B K. Abdominal aortic aneurysms ［J］. Prog Cardiovasc Dis， 2021， 65： 34-43.doi： 10.1016/j.pcad.2021.03.009 .
[3] ZHANG P， LIU C， LI J， et al. Risk factors for abdominal aortic aneurysm in general populations： A systematic review and meta-analysis ［J］. PLoS One， 2025， 20（9）： e0329500.doi： 10.1371/journal.pone.0329500 .
[4] KONTOPODIS N， GALANAKIS N， CHARALAMBOUS S， et al. Editor's Choice-Endovascular Aneurysm Repair in High Risk Patients： A Systematic Review and Meta-Analysis ［J］. Eur J Vasc Endovasc Surg， 2022， 64（5）： 461-474.doi： 10.1016/j.ejvs.2022.07.009 .
[5] WANHAINEN A， VAN HERZEELE I， BASTOS GONCALVES F， et al. Editor's Choice-European Society for Vascular Surgery （ESVS） 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms ［J］. Eur J Vasc Endovasc Surg， 2024， 67（2）.doi： 10.1016/j.ejvs.2023.11.002 .
[6] WANG C， GAO J， ZHANG H， et al. Early Outcome of WeFlow-JAAA Off-the-Shelf Endograft in the Treatment of Juxtarenal/Pararenal Abdominal Aortic Aneurysms ［J］. Ann Vasc Surg， 2025， 122（0）： 187-193.doi： 10.1016/j.avsg.2025.06.007 .
[7] GAO J P， WANG C A， ZHANG H P， et al. Anatomic feasibility of the WeFlow-JAAA endograft system for treating juxtarenal and pararenal abdominal aortic aneurysms ［J］. Sci Rep， 2025， 15（1）： 39818.doi： 10.1038/s41598-025-23485-y .
[8] FARUQI R M， CHUTER T A， REILLY L M， et al. Endovascular repair of abdominal aortic aneurysm using a pararenal fenestrated stent-graft ［J］. J Endovasc Surg， 1999， 6（4）： 354-358.doi： 10.1177/152660289900600411 .
[9] GREENBERG R K， CLAIR D， SRIVASTAVA S， et al. Should patients with challenging anatomy be offered endovascular aneurysm repair？ ［J］. J Vasc Surg， 2003， 38（5）： 990-996.doi： 10.1016/s0741-5214（03）00896-6 .
[10] DIBARTOLOMEO A D， PYUN A J， DING L， et al. Comparative outcomes of physician-modified fenestrated-branched endovascular repair of post-dissection and degenerative complex abdominal or thoracoabdominal aortic aneurysms ［J］. J Vasc Surg， 2023， 78（3）： 565-574.e562.doi： 10.1016/j.jvs.2023.05.005 .
[11] ZLATANOVIC P， JOVANOVIC A， TRIPODI P， et al. Chimney Versus Fenestrated Endovascular Versus Open Repair for Juxta/Pararenal Abdominal Aortic Aneurysms： Systematic Review and Network Meta-analysis of the Short-term Results ［J］. World J Surg， 2022， 47（3）： 803-823.doi： 10.1007/s00268-022-06829-x .
[12] WILSON E M， YAO K， KOSTIUK V， et al. Adherence to SVS Abdominal Aortic Aneurysm Guidelines Among Patients Detected by AI-Based Algorithm ［J］. Ann Vasc Surg， 2025， 120： 108-114. doi： 10.1016/j.avsg.2025.05.007 .
[13] LIU T， HU T， LU W， et al. Morphology and biomechanical index predict the rupture location and rupture risk of abdominal aortic aneurysm ［J］. Sci Rep， 2025， 15（1）：9604.doi： 10.1038/s41598-025-94828-y .
[14] LI S， WANG W， SUN X， et al. Monocentric Evaluation of Physician-Modified Fenestrations or Parallel Endografts for Complex Aortic Diseases ［J］. J Endovasc Ther， 2023， 31（5）： 936-948.doi： 10.1177/15266028221149918 .
[15] CHUN J Y， HAAN M D， MALEUX G， et al. CIRSE Standards of Practice on Management of Endoleaks Following Endovascular Aneurysm Repair ［J］. Cardiovasc Intervent Radiol， 2024， 47（2）： 161-176.doi： 10.1007/s00270-023-03629-1 .
[16] CHARISIS N， BOURIS V， CONWAY A M， et al. A Systematic Review and Pooled Meta-Analysis on the Incidence and Temporal Occurrence of Type II Endoleak Following an Abdominal Aortic Aneurysm Repair ［J］. Ann Vasc Surg， 2021， 75： 406-419.doi： 10.1016/j.avsg.2021.01.083 .
[17] REYES VALDIVIA A， MILNER R， HEIJMEN R， et al. Mid-term outcomes of the use of endoanchors during thoracic endovascular aortic repair in multicentre analysis ［J］. Vascular， 2022， 31（3）： 455-462.doi： 10.1177/17085381221076320 .
[18] TANEVA G T， LEE J T， TRAN K， et al. Long-term chimney/snorkel endovascular aortic aneurysm repair experience for complex abdominal aortic pathologies within the PERICLES registry ［J］. J Vasc Surg， 2020， 73（6）： 1942-1949.doi： 10.1016/j.jvs.2020.10.086 .
[19] PITOULIAS G A， FAZZINI S， DONAS K P， et al. Multicenter Mid-Term Outcomes of the Chimney Technique in the Elective Treatment of Degenerative Pararenal Aortic Aneurysms ［J］. J Endovasc Ther， 2021， 29（2）： 226-239.doi： 10.1177/15266028211047940 .
[20] PEI Y， WANG Z， HAO S， et al. Analysis of independent risk factors for aneurysm rupture based on carotid tortuosity index and morphological parameters of single intracranial aneurysms in anterior circulation ［J］. Clin Neurol Neurosurg， 2023， 234： 107993.doi： 10.1016/j.clineuro.2023.107993 .
[21] OLSON S L， PANTHOFER A M， BLACKWELDER W， et al. Role of volume in small abdominal aortic aneurysm surveillance ［J］. J Vasc Surg， 2021， 75（4）： 1260-1267.doi： 10.1016/j.jvs.2021.09.046 .
[22] BATH J， FAZZINI S， IPPOLITI A， et al. Chimney endovascular aneurysm repair （ChEVAR） for hostile neck complex aneurysm ［J］. Vascular， 2022， 30（6）： 1058-1068.doi： 10.1177/17085381211043951 .
[23] ZOTTOLA Z R， KRUGER J L， KONG D S， et al. Locoregional anesthesia is associated with reduced hospital stay and need for intensive care unit care of elective endovascular aneurysm repair patients in the Vascular Quality Initiative ［J］. J Vasc Surg， 2022， 77（4）：1061-1069.doi： 10.1016/j.jvs.2022.11.043 .
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