• Konstantinos P Donas, Jason T Lee, Mario Lachat, Giovanni Torsello, Frank J Veith, and PERICLES investigators.
• *Department of Vascular Surgery, St. Franziskus-Hospital Münster, Münster, Germany †Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA ‡Division of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland §Department of Vascular Surgery, St. Franziskus-Hospital Münster, and Clinic for Vascular and Endovascular Surgery, University of Münster, Münster, Germany ¶Division of Vascular Surgery, New York University Medical Center, New York, NY.
• Ann. Surg. 2015 Sep 1;262(3):546-53; discussion 552-3.

ObjectivesWe sought to analyze the collected worldwide experience with use of snorkel/chimney endovascular aneurysm repair (EVAR) for complex abdominal aneurysm treatment.BackgroundEVAR has largely replaced open surgery worldwide for anatomically suitable aortic aneurysms. Lack of availability of fenestrated and branched devices has encouraged an alternative strategy utilizing parallel or snorkel/chimney grafts (ch-EVAR).MethodsClinical and radiographic information was retrospectively reviewed and analyzed on 517 patients treated by ch-EVAR from 2008 from 2014 by prearranged defined and documented protocols.ResultsA total of 119 patients in US centers and 398 in European centers were treated during the study period. US centers preferentially used Zenith stent-grafts (54.2%) and European centers Endurant stent-grafts (62.2%) for the main body component. Overall 898 chimney grafts (49.2% balloon expandable, 39.6% self-expanding covered stents, and 11.2% balloon expandable bare metal stents) were placed in 692 renal arteries, 156 superior mesenteric arteries (SMA), and 50 celiac arteries. At a mean follow-up of 17.1 months (range: 1-70 months), primary patency was 94%, with secondary patency of 95.3%. Overall survival of patients in this high-risk cohort for open repair at latest follow-up was 79%.ConclusionsThis global experience represents the largest series in the ch-EVAR literature and demonstrates comparable outcomes to those in published reports of branched/fenestrated devices, suggesting the appropriateness of broader applicability and the need for continued careful surveillance. These results support ch-EVAR as a valid off-the-shelf and immediately available alternative in the treatment of complex abdominal EVAR and provide impetus for the standardization of these techniques in the future.

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