E-learning
Latest clinical evidence on ChEVAR: What is next? Writing that clinical evidence on chimney endovascular aneurysm repair (ChEVAR) has “flourished” in the last decade, Gergana T Taneva highlights key elements of the most recent research on the technique. CHEVAR HAS SHOWN comparable results to fenestrated EVAR (FEVAR) for the treatment of juxtarenal abdominal aortic aneurysms (jAAA).1–3 The clinical evidence on ChEVAR has flourished in the last decade, with an increasing number of key publications released within recent years.4–8 ChEVAR has gained popularity to the point that its role within the AAA treatment algorithm is considered complementary depending on a patient’s characteristics and aortoiliac anatomy.9 However, cost-
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effectiveness issues, long-term outcomes, and procedural tips such as the deal with angulated renal arteries remain unknown. In this context, we present an overview of the latest evidence and publications on these appealing topics (Table 1). 1. Widely spoken of and much needed, a cost analysis and comparison of both techniques, ChEVAR and FEVAR, was performed, evaluating all elective and symptomatic patients treated at St Franziskus Hospital in Münster, Germany, for jAAA by single or double chimney (n=111) or by FEVAR with three fenestrations (n=37) between 2013 and January 2017.10 The cost-effectiveness analysis was defined as the summary of material costs, in-hospital costs, and additional costs due to procedurerelated reinterventions. Index procedure and hospitalisation median costs were higher for FEVAR (€42,116 vs. €22,171, p<0.001). The median overall costs, including costs after reinterventions during follow-up, remain higher for FEVAR (€42,128 vs. €22,872, p<0.001) for a follow-up period of almost four years.10 Six patients (5.4%) in the ChEVAR group required readmission compared to three
patients (8.1%) who required readmission for reinterventions in the FEVAR group (p=0.69). Both FEVAR and ChEVAR proved to be expensive and technicallydemanding interventions for the treatment of juxtarenal aortic pathologies. However, ChEVAR was significantly more cost-effective compared to FEVAR at comparable readmission rates for reinterventions.11 2. Also highly-anticipated, and extension of the follow-up and long-term evaluation of the multicentric PERICLES Registry was performed analysing clinical and radiographic data from patients treated with ChEVAR between 2008 and 2014.12 A subgroup of 244 patients with 387 chimney grafts placed and follow-up of at least 30 months was used to analyse specific anatomic and device predictors of adverse events. In the subgroup, the technical success was 88.9%, while primary patency was 94%, 92.8%, 92%, and 90.5% at two-and-a-half years, three years, four years, and five years, respectively. Mean aneurysm sac regression was 7.8±11.4mm, p<0.0001. Chimney graft occlusion occurred in 24 target vessels (6.2%). Late open conversion was required in January 2021
