Chimney technique is an assistive technology of endovascular aortic repair, which is used to reconstruct the vital branch vessel invaded by aortic pathology. In chimney technique, most of the commercial aortic stent-graft can be used, and covered branch stent-graft is recommended to decrease the risk of type I a endoleak. The suggested oversizing for aortic stent-graft and branch stent-graft is 15% and 5% respectively, and the length of overlapping between stent-grafts should be more than 2 cm. Type I a endoleak is the main concentration, appropriated oversizing and overlapping are important precautions theoretically. Anticoagulation therapy post-operation is crucial in preventing restenosis of the chimney stent-graft.
Aorta ; pathology ; surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; Endoleak ; prevention & control ; Endovascular Procedures ; Humans ; Prosthesis Design ; Stents

OBJECTIVETo evaluate and report surgical management and experience of atypical ruptured abdominal aortic aneurysm (RAAA).

METHODSClinical data of 52 RAAA patients from May 2002 to February 2015 were retrospectively collected and analyzed. Thirty-three cases were included into this study based on atypical clinical presentation and etiology, including 6 infected RAAA, 5 inflammatory RAAA, 1 traumatic aortic rupture, 6 tuberculotic RAAA, 2 aoritc-vena cava fistula, 3 intestinal fistula and 5 spine erosion cases. Two of them refused operation during preparation, 19 of them received emergency open repair and 13 of them received endovascular aortic repair (EVAR) with 1 case converted to open surgery.

RESULTSThe systolic blood pressure of atypical RAAA before operation was (88±16) mmHg (1 mmHg=0.133 kPa), duration time from admission to diagnosis making was (17±10) hours. Perioperative death occurred in 1 patient because of hemorrhagic shock induced acidosis. During follow-up for 3 to 72 months, no operation related complications occured, such as artificial graft infection.

CONCLUSIONSEmergent operation including open surgery and EVAR is crucial for RAAA treatment. Early diagnosis, excellent operative techniques and comprehensive perioperative management are measures conducive to reduce the mortality rate of RAAA.

Aortic Aneurysm, Abdominal ; surgery ; Aortic Rupture ; surgery ; Humans ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome ; Vascular Surgical Procedures