Advanced Techniques for Treating Juxtarenal and Pararenal Abdominal Aortic Aneurysms: Chimneys, Periscopes, Sandwiches and Other Methods

The complex aortic anatomy of patients who present with juxtarenal and pararenal abdominal aortic aneurysms requires advanced techniques to ensure adequate coverage and complete exclusion of the aneurysm. Parallel stent grafting is one option for endovascular repair of complex aneurysms. Using chimneys, periscopes, or snorkels, it is possible to extend the length of the proximal seal zone and maintain perfusion to branch vessels. Because readily available stent grafts and covered stents are used, this technique is highly adaptable to each patient's unique anatomical challenges. However, the complexity of these procedures requires careful preoperative planning, excellent intraoperative imaging capabilities, a thorough understanding of technique, and anticipation of potential procedural pitfalls and complications. We present our experience with chimney/snorkel and sandwich techniques as a reliable and effective treatment strategy for complex aortic aneurysm repair.