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Endovascular repair of thoracic and abdominal aortic aneurysms is safe, durable, and effective but only when there is adequate sealing and fixation at the attachment sites. The introduction of fenestrated and branched stent-grafts has made it possible to perform endovascular aneurysm repair (EVAR) when the presence of an aortic arch or visceral artery branches do not have an adequate proximal or distal sealing zone. However, both fenestrated and branched stent-grafts are expensive, timeconsuming to manufacture, and unavailable for routine use in the US.
Greenberg et al.1 first described preservation of renal perfusion during EVAR using the "snorkel" or "chimney graft" technique, with placement of an adjunctive stent into the renal artery alongside the stent-graft to treat a juxtarenal aortic aneurysm. Since then, others have expanded on this technique to treat juxtarenal, pararenal, and aortic arch aneurysms to preserve or restore flow to aortic branches that were intentionally or accidentally covered during EVAR.2-6
The report by Lachat et al.7 in this issue of JEVT describes the successful treatment of a ruptured type IV thoracoabdominal aortic aneurysm (TAAA) using a completely endovascular approach, with revascularization of all 4 visceral arteries through chimney grafts. The particular chimney technique described in the article is feasible only when the aneurysm is relatively...