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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe majority of aortic abdominal aneurysms (AAAs) in the United States are repaired using an endovascular approach. Evolving techniques and technology have expanded the population eligible for an endovascular approach making it possible to use this approach in patients who were previously not considered good candidates.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe majority of aortic abdominal aneurysms (AAAs) in the United States are repaired using an endovascular approach. Evolving techniques and technology have expanded the population eligible for an endovascular approach making it possible to use this approach in patients who were previously not considered good candidates according to Patricio Rosa, MD, Delray Medical Center, Delray Beach, Florida, USA. Dr. Rosa also noted that novel techniques and devices may further increase the number of endovascular procedures.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAAAs occur in \u223c2% to 5% of men aged \u0026gt;60 years and result in 9000 deaths per year in the United States. Open surgical repair was been the treatment of choice for many years; however, this procedure is associated with a high morbidity and mortality in some patient populations. For example, some studies have shown that the 1-year mortality of high-risk patients aged \u0026gt;70 years with chronic obstructive pulmonary disorder who undergo a suprarenal cross clamp can be as high as \u223c30% [Beck A et al. \u003Cem\u003EJ Vasc Surg\u003C\/em\u003E 2009]. Therefore, physicians have developed the chimney technique (stenting side branches), which is one technique that allows the physician to perform the procedure through an endovascular approach (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/14\/27\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The Chimney Technique\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-728548704\u0022 data-figure-caption=\u0022The Chimney Technique\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/14\/27\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/14\/27\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/14\/27\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13690\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EThe Chimney Technique\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced from Bruen KJ et al. Endovascular chimney technique versus open repair of juxtarenal and suprarenal aneurysms. J Vasc Surg 2011;53(4):895\u2013905. With permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-5\u0022\u003EEarly data suggests that the chimney technique may provide results that are similar to open procedures in terms of success of repair even when the patient has anatomy that makes traditional endovascular repair difficult, said Dr. Rosa. In a nonrandomized study of 21 patients with juxtarenal or pararenal aneurysms who underwent repair using the chimney technique and were compared with 21 matched open cases, mortality was similar at 4.8% in each group (one death in each group). The frequency of renal dysfunction was also similar between the two groups occurring in 6 patients (29%) in the endovascular group and 5 patients (1 patient with acute kidney injury and 4 patients with acute renal failure) in the open group. Dr. Rosa pointed out that this yielded a rate of renal complications similar to that found in the literature for open cases in which the renal cross-clamp is performed [Bruen KJ et al. \u003Cem\u003EJ Vasc Surg\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAnother technique that makes percutaneous aneurysm repair possible is the preclose method. This technique prepares the arteriotomy for percutaneous repair prior to removal of the sheath. This method was successful in 94.3% of cases according to a study in which 559 Proglide devices were used to repair 279 femoral arteries [Lee WA et al. \u003Cem\u003EJ Vasc Surg\u003C\/em\u003E 2007]. There were only 16 failures, some of which were attributed to patient obesity and severe calcifications of the artery. Dr. Rosa commented that even in the presence of severely calcified vessels, the preclose method could still be performed if used in conjunction with an ultrasound device.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003ECustom-made fenestrated grafts used to accommodate visceral arteries is another way to increase the available proximal landing zone in difficult to treat patients. According to a retrospective observational study conducted at the Cleveland Clinic [Greenberg RK et al. \u003Cem\u003EJ Vasc Surg\u003C\/em\u003E 2009], 30 patients were treated with fenestrated devices over a 1-year period, with a 100% procedural success rate. Two-year follow-up data was available for 23 patients, and showed that 69.6% of the patients experienced a decrease in size of their aneurysm. There were no aneurysm-related deaths, ruptures, or conversions into open repair at 2-year follow-up.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EDr. Rosa concluded that percutaneous repair of aneurysms has now become the predominant method of performing the procedure and will likely become even more widespread with the invention of new techniques and devices which expand their indication.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/14\/27.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzno01\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzno01\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}