Parallel Endografting And Chimney Endovascular (PEACE) registry outcomes in emergency repair of complex abdominal aortic aneurysms

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.