Chimney in Ruptured Abdominal Aortic Aneurysms: A Retrospective Analysis of 14 Years in a cohort treated only by endovascular repair

Objective Ruptured abdominal aortic aneurysm (rAAA) carries an extremely high mortality rate. Chimneys are used in order to gain proximal landing zone for sealing when the aortic neck is hostile due to conicity or distance to the renal arteries are not optimal. This study aimed to retrospectively evaluate the outcomes of patients with rAAA treated in a endovascular only center over a 14 years period, comparing those who underwent Chimney Endovascular Aortic Repair (Ch-EVAR) with those who received standard Endovascular Aortic Repair (EVAR). Methods This single-center, retrospective observational study included all patients with a CT-confirmed rAAA between October 2009 and October 2023. All the patients treated only endovascular. Patient demographics, risk factors, anatomical characteristics, perioperative variables, and postoperative outcomes were analyzed and compared between the Ch-EVAR and EVAR groups. Results A total of 121 (mean age 75) patients underwent endovascular repair for rAAA, with 19 patients receiving at least one chimney (Ch-EVAR) and 93 undergoing standard EVAR. A total of 28 chimney grafts were deployed in the Ch-EVAR group. There were no significant differences in 30 days or 1 year mortality, complication rates, or postoperative renal function between the groups. However, the incidence of type Ia endoleaks was significantly higher in the Ch-EVAR group compared to the EVAR group (p<0.05). Conclusion Ch-EVAR is a viable option for rAAA patients with unfavorable aortic neck anatomy when performed in specialized centers, offering comparable perioperative outcomes and mortality rates to standard EVAR. However, the increased risk of type Ia endoleaks warrants careful patient selection and long-term surveillance.