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Parallel Endografting And Chimney Endovascular (PEACE) registry outcomes in emergency repair of complex abdominal aortic aneurysms

Karelis, Angelos LU orcid ; Adam, Donald ; Piazza, Michele ; Tinelli, Giovanni ; Gallito, Enrico ; Matsagkas, Miltiadis ; Mees, Barend ; Mani, Kevin ; D’Oria, Mario and Mansour, Wassim , et al. (2026) In British Journal of Surgery 113(1).
Abstract

Background: Chimney endovascular aneurysm repair (chEVAR) techniques have been described to manage a group of patients who are unsuitable for either open aortic aneurysm surgery or a variety of standard endovascular repair techniques. The aim of this study was to assess the long-term clinical outcomes of chEVAR in emergency settings for patients with abdominal aortic aneurysms that have complex morphology. Methods: This was a multicentre retrospective study that included all consecutive patients undergoing urgent chEVAR with at least one chimney/parallel graft up to June 2021. Outcomes that were captured included 30-day mortality, long-term overall survival, aneurysm-related mortality, chimney-related complications, and target vessel... (More)

Background: Chimney endovascular aneurysm repair (chEVAR) techniques have been described to manage a group of patients who are unsuitable for either open aortic aneurysm surgery or a variety of standard endovascular repair techniques. The aim of this study was to assess the long-term clinical outcomes of chEVAR in emergency settings for patients with abdominal aortic aneurysms that have complex morphology. Methods: This was a multicentre retrospective study that included all consecutive patients undergoing urgent chEVAR with at least one chimney/parallel graft up to June 2021. Outcomes that were captured included 30-day mortality, long-term overall survival, aneurysm-related mortality, chimney-related complications, and target vessel patency. Results: Some 118 patients (mean(s.d.) age of 77(8) years; 72.0% male) underwent urgent or emergency chEVAR, 78 (66.1%) due to aortic rupture. The mean(s.d.) number of chimneys used per patient was 1.6(0.7). Technical success was achieved in 90.6% of patients, with a 30-day mortality rate of 17.7%. The mean follow-up was 4(3) years. Estimated overall survival was 69 ± 5% at 3 years, 45 ± 6% at 5 years, and 32 ± 6% at 7 years. Freedom from aneurysm-related mortality was 58 ± 6% at 5 years and 53 ± 6% at 7 years. In patients surviving the perioperative 30-day interval, freedom from aneurysm-related mortality was 73 ± 6% at 5 years and 66 ± 7% at 7 years. Primary target vessel patency at 5 and 7 years was 87 ± 4%, with renal arteries most frequently affected. Late reinterventions occurred in 16.1% of patients, mostly for type Ia endoleaks (8 of 25 reinterventions (32%)) and type Ib endoleaks (5 of 25 reinterventions (20%)). Conclusion: In this Parallel Endografting And Chimney Endovascular (PEACE) registry study, chEVAR was associated with a high rate of technical success and acceptable early outcomes, but, in the longer term, was associated with high rates of reintervention and mortality. It appears to represent a reasonable alternative technique for patients presenting as an emergency with complex aortic aneurysm morphology when standard open and endovascular techniques are not feasible.

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type
Contribution to journal
publication status
published
subject
in
British Journal of Surgery
volume
113
issue
1
article number
znaf278
publisher
Oxford University Press
external identifiers
  • scopus:105026310228
  • pmid:41467577
ISSN
0007-1323
DOI
10.1093/bjs/znaf278
language
English
LU publication?
yes
additional info
Publisher Copyright: © The Author(s) 2025.
id
a10ac459-e9c8-461f-987e-0632b2a8ca7f
date added to LUP
2026-03-24 13:03:20
date last changed
2026-04-21 17:06:56
@article{a10ac459-e9c8-461f-987e-0632b2a8ca7f,
  abstract     = {{<p>Background: Chimney endovascular aneurysm repair (chEVAR) techniques have been described to manage a group of patients who are unsuitable for either open aortic aneurysm surgery or a variety of standard endovascular repair techniques. The aim of this study was to assess the long-term clinical outcomes of chEVAR in emergency settings for patients with abdominal aortic aneurysms that have complex morphology. Methods: This was a multicentre retrospective study that included all consecutive patients undergoing urgent chEVAR with at least one chimney/parallel graft up to June 2021. Outcomes that were captured included 30-day mortality, long-term overall survival, aneurysm-related mortality, chimney-related complications, and target vessel patency. Results: Some 118 patients (mean(s.d.) age of 77(8) years; 72.0% male) underwent urgent or emergency chEVAR, 78 (66.1%) due to aortic rupture. The mean(s.d.) number of chimneys used per patient was 1.6(0.7). Technical success was achieved in 90.6% of patients, with a 30-day mortality rate of 17.7%. The mean follow-up was 4(3) years. Estimated overall survival was 69 ± 5% at 3 years, 45 ± 6% at 5 years, and 32 ± 6% at 7 years. Freedom from aneurysm-related mortality was 58 ± 6% at 5 years and 53 ± 6% at 7 years. In patients surviving the perioperative 30-day interval, freedom from aneurysm-related mortality was 73 ± 6% at 5 years and 66 ± 7% at 7 years. Primary target vessel patency at 5 and 7 years was 87 ± 4%, with renal arteries most frequently affected. Late reinterventions occurred in 16.1% of patients, mostly for type Ia endoleaks (8 of 25 reinterventions (32%)) and type Ib endoleaks (5 of 25 reinterventions (20%)). Conclusion: In this Parallel Endografting And Chimney Endovascular (PEACE) registry study, chEVAR was associated with a high rate of technical success and acceptable early outcomes, but, in the longer term, was associated with high rates of reintervention and mortality. It appears to represent a reasonable alternative technique for patients presenting as an emergency with complex aortic aneurysm morphology when standard open and endovascular techniques are not feasible.</p>}},
  author       = {{Karelis, Angelos and Adam, Donald and Piazza, Michele and Tinelli, Giovanni and Gallito, Enrico and Matsagkas, Miltiadis and Mees, Barend and Mani, Kevin and D’Oria, Mario and Mansour, Wassim and Cieri, Enrico and Kölbel, Tilo and Sonesson, Björn and Dias, Nuno V.}},
  issn         = {{0007-1323}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{1}},
  publisher    = {{Oxford University Press}},
  series       = {{British Journal of Surgery}},
  title        = {{Parallel Endografting And Chimney Endovascular (PEACE) registry outcomes in emergency repair of complex abdominal aortic aneurysms}},
  url          = {{http://dx.doi.org/10.1093/bjs/znaf278}},
  doi          = {{10.1093/bjs/znaf278}},
  volume       = {{113}},
  year         = {{2026}},
}