Comparison of standard endovascular repair and chimney graft for juxtarenal abdominal aortic aneurysm

Comparison of standard endovascular repair and chimney graft for juxtarenal abdominal aortic aneurysm | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of standard endovascular repair and chimney graft for juxtarenal abdominal aortic aneurysm Mingshan Wang, Huoying Cai, Zhen Liu, Lin Huang, Ruiming Liu, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3800230/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study compared the efficacy of standard grafting (S-EVAR) and chimney grafting (Ch-EVAR) for treating juxtarenal abdominal aortic aneurysms(JAAA). Methods Data of patients with JAAA, who underwent S-EVAR and Ch-EVAR from January 2015 to December 2021 were collected. Follow-up was performed by CTA and ultrasonography of the aorta were performed before discharge, at 6 and 12 months postoperatively, and annually thereafter. Main outcome measures: AAA-related mortality, type Ia endoleak and reoperation Results A total of 62 patients underwent S-EVAR and 23 underwent Ch-EVAR. The proportion of men who underwent S-EVAR (91.9%, 57/62) was higher than the proportion who underwent Ch-EVAR (69.6%, 16/23) (p = 0.023). The postoperative incidence rate of type Ia endoleak was lower in S-EVAR (9.7% vs 13%, p = 0.698). Times for. hospitalization, ICU monitoring, operation, and anesthesia, and perioperative bleeding were less in S-EVAR (12 vs 17 days, 0 vs 1 day, 122.5 vs 220 min, 177.5 vs 300 min, 50 vs 100 mL, p < 0.05). In S-EVAR, a suprarenal aortic angle was associated with type Ia endoleak (p = 0.016). Median follow-up duration was 48 months, (range, 0–94 months) in the S-EVAR group and 42 months (range, 0–90 months) in the Ch-EVAR group. 1-year survival rate were (91.9% vs 91.3%), 3-year survival rate (81.7% vs 78.7%), 5-year survival rate (62.2% vs 45.8%) were not statistically different. No significant differences were found in postoperative complications. The long-term patency rate of chimney stent was 100%. Conclusions The off-label use of S-EVAR for JAAA, with a straight and 8–10 mm aortic neck length, can be considered safe and effective. Ch-EVAR is more suitable for JAAA with excessive twisting of the neck (suprarenal aortic angle < 114°). In this study, long-term data of both technologies showed satisfactory results in preventing aneurysm rupture and the related mortality. abdominal aortic aneurysm endoleak endovascular aneurysm repair postoperative complications treatment outcome Figures Figure 1 INTRODUCTION Endovascular aneurysm repair (EVAR) has gradually taken over from open surgical repair (OSR) for the repair of abdominal aortic aneurysms (AAA) because mortality and complication rates of EVAR are significantly lower than with OSR. 1,2 However, EVAR is not indicated in certain AAA patients because of unsuitable anatomical characteristics. The ESVS guidelines define JAAA as an abdominal aneurysm with a short neck (< 10mm) but not involving the renal arteries. 3 JAAA accounts for approximately 15% of all AAA. 4 According to the instructions for use (IFU)of the majority of manufacturers, the JAAA owe to its short neck ༜10 mm not be suitable for standard EVAR (S-EVAR). Therefore, many techniques, such as fenestrated and branch stent technologies, have been used for endovascular treatment. However, the applicability of these techniques is limited by the anatomical characteristics of the neck, high costs, and lengthy manufacturing lead times. 5 Therefore, those techniques are unsuitable for emergency treatment of a ruptured JAAA. Greenberg et al. 6 first used renal stents combined with an aortic stent graft to treat JAAA. This technique does not need to be customized and can be combined with conventional stents according to a patient’s specific requirement. Chimney EVAR (Ch-EVAR) has since become widely used in clinical practice. However, due to the “gutters” located between the aorta and the stent graft, the risk of a type Ia endoleak is relatively high, and the endoleak incidence rate continues to rise with increasing numbers of reconstructed visceral vessels. The reported perioperative endoleak incidence rate of Ch-EVAR is > 14%. 7 Some authors suggested using off-label standard stents to treat JAAA in patients who are unfit for OR. 8 Few papers have reported the early clinical results with small cohorts of S-EVAR for JAAA. 9 Until now, no retrospective series have compared S-EVAR and Ch-EVAR for JAAA. Therefore, this study aimed to compare the clinical outcomes of S-EVAR and Ch-EVAR for JAAA. METHODS Patients. All consecutive patients with JAAA were treated with S-EVAR or Ch-EVAR between January 2015 and December 2021 in a tertiary vascular unit (Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China). This research follows the principles outlined in the Declaration of Helsinki and informed consent was obtained from all participants. Ethical approval for this study was obtained from the Independent Ethics Committee for Clinical Research and Animal Trials of the First Affiliated Hospital of Sun Yat-sen University at the commencement of this study. Inclusion criteria. JAAA including short-necked infrarenal (< 10 mm) and juxtarenal. The choice between S-EVAR and Ch-EVAR was determined by clinical and anatomic characteristics. Patients who required reconstruction of branch vessel were considered to be treated by Ch-EVAR. Exclusion criteria. ( 1 ) ruptured or near-ruptured JAAA requiring emergency surgery, ( 2 ) AAA caused by inflammation, infection, or other causes, and ( 3 ) aortic pseudoaneurysm or dissection. Preoperative assessment. All patients were assessed by performing computed tomography angiography (CTA) and ultrasonography preoperatively. Definitions Chronic obstructive pulmonary disease was defined as FEV1/FVC < 70%. Hypertension, coronary heart disease and diabetes were identified in patients receiving medical treatment for these conditions. Renal function was graded according to serum creatinine values from I to V (I: 707 mmol/L). Renal insufficiency refers to serum creatinine values > 133 mmol/L. 10 The α neck angle was defined as the angle between the suprarenal aortic and the infrarenal neck. The β neck angle was defined as the angle between infrarenal neck and the aneurysm. Severe calcification or thrombosis was defined as ≥ 50% of the neck circumference according to the study by Chaikof et al. 11 The conical neck was defined as being within 10 mm below the level of the renal artery, with the abdominal aorta diameter dilated ≥ 2 mm. S-EVAR procedure. The patient was placed in the supine position under general anesthesia, a longitudinal incision was made at the pulsating femoral arteries on both sides of the groin, the femoral arteries were punctured using the Seldinger method. Digital subtraction angiography was performed to determine anatomical characteristics, and the origin of major branches of the abdominal aorta. In combination with the preoperative imaging examination, this allowed the corresponding specification of the covered stent to be selected, and the main stent was delivered slowly to the proximal neck anchoring area through the femoral artery. After cannulation of the contralateral iliac gate, the iliac limb was inserted through the opposite side of the guidewire and deployed. Angiography was performed again to identify a potential endoleak. If an Ia endoleak was found, balloon dilation optimized the sealing of the endograft. If there is a still significant Ia endoleak after balloon dilation, we will insert chimney stents to extend proximal anchoring area and cuff was implanted proximal to the main stent to eliminate the Ia endoleak. The main stents used were the Endurant (Medtronic, Minneapolis, MN, USA), Excluder (Gore Medical, Flagstaff, AZ, USA), Sinus XL (Optimed Medical Instruments GmbH, Ettlingen, Germany), Huamai Tianzhuo (Huaimai Taike Medical Device Co., Ltd., Beijing, China), and Minos (MicroPort Endovascular MedTech Group Co., Ltd., Shanghai, China). The oversizing used for the main stent was between 20% and 30%, according to the neck diameter and angles. The most frequently used stent design in the S-EVAR group was a Endurant (Medtronic, USA) (39 of 62). Ch-EVAR procedure. This was performed as for the S-EVAR, but we used a left brachial artery approach and inserted chimney stents before delivering the main aortic stent. Chimney stents include: Viabhan (Gore, USA), Omnilink Elite (Abbott, USA), Absolute (Abbott, USA), Protege GPS (EV3,USA), Innova(Boston Scientific, USA), Pulsar-18 (BioTronic, German). The most frequently used chimney stent was a Viabhan (Gore, USA) (17 of 23). The chimney grafts usage data are presented in table III Follow-up protocol. CTA and ultrasonography of the aorta were performed before discharge, at 6 and 12 months postoperatively, and annually thereafter. Statistical analysis. Statistical evaluation was performed using SPSS software version 23 (IBM Corp., Armonk, NY, USA). When appropriate, categorical variables were analyzed using the chi-squared test or Fisher’s exact test; continuous variables were analyzed using the Student’s t-test or Mann–Whitney U test. Time-to-event analysis was performed using Kaplan–Meier curves for overall survival. Logistic regression was used to analyze the relationship between anatomical characteristics of the neck and complications. The p-values were then determined; the significance level was p < 0.05. The Yoden index was used to calculate the critical value of the proximal neck angulation. The Yoden index = sensitivity + specificity – 1 , ranging from 0 to 1. The greater the Yoden index, the better the effect of the screening test; the critical diagnostic value of this method is the value of the test variable corresponding to its maximum value. RESULTS Patient characteristics. A total of 85 patients were enrolled: 63 patients (57 of whom were men) underwent S-EVAR and 23 (16 men) underwent Ch-EVAR. The demographic characteristics and underlying diseases of the patients are detailed in Table I. The proportion of men who underwent S-EVAR (91.9%, 57/62) was greater compared with the proportion who underwent Ch-EVAR (69.6%, 16/23) (p = 0.023). In addition, significant differences were found between the S-EVAR group and Ch-EVAR group in smoking (59.7% vs 4.3%) and alcohol consumption (16.1% vs 56.5%) (p < 0.01). However, differences between the two groups in age and underlying diseases were not significant. JAAA anatomic data. In S-EVAR and Ch-EVAR groups, the neck length (8.09 ± 0.12 vs 5.9 ± 0.3 mm), neck diameter ((26.05 ± 0.49 vs 27.49 ± 0.78 mm), aneurysm diameter (57.2 ± 15.9 vs 65.4 ± 12.1 mm), suprarenal angle (162.9 ± 26° vs 149.5 ± 29.6°), infrarenal angle (144.1 ± 31° vs 119.5 ± 31.6°). The anatomical data for JAAA are shown in Table II. Intraoperative stent usage . The stents used in this study were the Endurant (Medtronic, Minneapolis, MN, USA), Excluder (Gore Medical, Flagstaff, AZ, USA), Sinus XL (Optimed Medical Instruments GmbH, Ettlingen, Germany), Huamai Tianzhuo (Huaimai Taike Medical Device Co., Ltd., Beijing, China), and Minos (MicroPort Endovascular MedTech Group Co., Ltd., Shanghai, China). The analysis indicated no significant differences in the incidence of type Ia endoleak in different main body endograft brands (p > 0.05). The effects of different brands of stents on type Ia endoleak in S-EVAR and Ch-EVAR are listed in table III Intraoperative and hospitalization-related data. Intraoperative and hospitalization-related data are presented in table IV. The S-EVAR group was superior to the Ch-EVAR in terms of hospitalization time, ICU monitoring time, operation time, anesthesia time, and perioperative bleeding (p < 0.05). Perioperative events . The perioperative events are listed in Table V. In S-EVAR there were three (4.8%) type Ia endoleak. One underwent conversion to OR for AAA rupture at 7 days and died (1/62, 1.6% proximal neck -related mortality). Two were follow-up observations due to minor type Ia endoleak. Among them, one sealed by endovascular repair at 12 months and another one continued observing. Another one (1.6%) patient was performed reintervention (Iliac leg extension) due to type Ib endoleak at 3 days. In Ch-EVAR there were three (13%) type Ia endoleak. All of them were follow-up observations in view of minor type Ia endoleak. Among them, one sealed by endovascular repair at 6 months. Another three (13%) patients were performed reoperation, including a pseudoaneurysm of the left brachial artery at 10 days, a right renal hemorrhage at 7 days and a right femoral artery thrombosis at 1 day. The chimney grafts usage and reconstruction of branching arteries are presented in table VI. Follow-up mortality and complications . Follow-up mortality and complications are summarized in Table VII. Median follow-up duration was 48 months, (range, 0–94 months) in the S-EVAR group and 42 months (range, 0–90 months) in the Ch-EVAR group. In S-EVAR there were three (4.8%) type Ia endoleak. Two were sealed by endovascular repair at 18 and 24 months. One reject reoperation at 36 months. And there were two aneurysm-related deaths in the S-EVAR group; one death was due to a postoperative stent extrusion that led to JAAA rupture at 11month, and one patient died of sepsis due to stent infection 1 month after surgery. There were 5 of 62 (11.3%) reinterventions during follow-up including: 2 type Ia endoleak, 2 type II endoleak, and 1 type Ib endoleak . No new type Ia endoleak and aneurysm-related deaths occurred in the Ch-EVAR group. There were 2 of 23 (%) reinterventions during follow-up including: 1 type Ia endoleak, 1 type II endoleak. The patency rate of chimney stent was 100%. Analysis of factors related to type Ia endoleak. The incidence of type Ia endoleak following S-EVAR was negatively associated with the α neck angle. Patients with type Ia endoleak had a smaller α neck angle. The Yoden index calculated a critical value of 114° for the α neck angle in the S-EVAR. When the α neck angle was 114°: 50%vs 6.9%, (p = 0.005) (Table VIII). In contrast, the incidence of type Ia endoleak in the Ch-EVAR was not related to the proximal neck. (Table IX) Survival analysis . The estimated overall survival rates were similar in both groups (Fig. 1 ). S-EVAR 1-year survival rate were 91.9%, 3-year survival rate 81.7%, 5-year survival rate 62.2%, respectively. The Ch-EVAR 1-year survival rate 91.3%, 3-year survival rate 78.7%, 5-year survival rate 45.8%, all lower than those of S-EVAR. But the difference was not statistically significant (P = 0.288). DISCUSSION In this study, we compared the perioperative and follow-up results of S-EVAR and Ch-EVAR and found no statistical differences in type Ia endoleak, AAA-related mortality and reoperation. Performing Ch-EVAR for the treatment of JAAA was first reported by Greenberg et al. 6 in 2003 and has achieved good results by effectively maintaining the blood supply to the branch artery. Studies have shown that the long-term patency rate of renal artery chimney stents exceeds 97%. 12 In contrast to fenestrated and branch stent technologies, Ch-EVAR does not require customization based on the vascular anatomical characteristics of each patient. They can be combined with conventional stents according to specific patient requirements and are suitable for emergency surgery or AAA patients with perioperative emergencies. They are relatively easy to use and widely used in clinical practice. However, the gap between the chimney stent, main stent, and aortic wall results in a relatively high risk of type Ia endoleak. The Protagoras study 13 included 128 patients with 187 implanted chimney stents (160 RA, 15 ARA, 10 SMA, and 2 CA), with a 30-day mortality rate of 0.8%, an average follow-up of 24.6 months, and a type Ia endoleak rate of 1.6%. The primary and secondary intervention rates were 95.7% and 93.1%, respectively. Therefore, postoperative complications, such as type Ia endoleak and renal insufficiency, remain an issue following Ch-EVAR. In addition, Ch-EVAR has certain requirements for the operator’s intracavity technology and costs 2–3 times more than S-EVAR. With continuous improvements in endovascular repair instruments and increasing endovascular experience, the surgical indications for S-EVAR have gradually increased. Greenberg et al 8,14 indicateed that challenging aortic anatomy and short proximal neck are not contraindications to EVAR in patients. Recently, Gallitto et al 15 reported that EVAR may be safely performed in JAAA (outside the IFU) by use of suprarenal fixation stents. Matsagkas et al. 16 compared the clinical effects of the Endurant stent in AAAs with short (< 10 mm) and long aneurysm necks. Except for a small aneurysm neck angle in the short aneurysm neck group, no type I endoleak was observed in either group during the follow-up period. Furthermore, no significant differences were found between the two groups for secondary intervention or aneurysm-related mortality. This finding indicates that even if the patient’s aneurysm neck length is less than 10 mm, as long as the aneurysm neck is not too twisted, an Endurant stent can achieve good clinical results. The advantage of one technique over another is unclear because of the scarcity of reports comparing these two techniques. The most relevant reports are on the short- and long-term effects of S-EVAR and Ch-EVAR, respectively; comparative studies between the two surgical methods are lacking. Therefore, current evidence is insufficient for determining which is the most appropriate method for the treatment of JAAA. Some experts may choose Ch-EVAR because of its theoretical superiority; others may prefer S-EVAR to avoid potential technical difficulties and type Ia endoleaks. At our institution, most patients who undergo S-EVAR have longer neck lengths, smaller neck diameters and bigger suprarenal or infrarenal aortic angles. This study aimed to provide data to aid in deciding between S-EVAR and Ch-EVAR for the treatment of JAAA. In this study, all early- and long-term analyses showed no significant difference in the rate of AAA-related mortality, type Ia endoleak and reoperation between the two groups despite ( 1 ) smaller suprarenal and infrarenal aortic angles in Ch-EVAR, ( 2 ) longer neck length in the S-EVAR group. In our study, S-EVAR had advantages over Ch-EVAR in terms of hospitalization time, ICU monitoring time, operative time, anesthesia time, and perioperative bleeding. Therefore, S-EVAR is a safe and effective treatment method for patients with JAAA who are generally poor and have difficulty tolerating a long operation time. Renal insufficiency is another important factor; the incidence is 1–23%. 17 Several reasons for postoperative renal insufficiency after EVAR have been suggested: ( 1 ) renal injury caused by the large amounts of contrast used during surgery, and ( 2 ) renal ischemia caused by suprarenal fixation or renal artery stent occlusion. In the current study, the incidence of postoperative renal injury in both groups of patients was low (S-EVAR: 12.9%; Ch-EVAR: 8.7%; p > 0.05). Ch-EVAR may be a better option to prevent renal insufficiency. Compared with S-EVAR, Ch-EVAR is more suitable for JAAA involving a short neck length (< 5 mm) and excessive twisting of the neck (suprarenal aortic angle < 114°). In this study, 23 patients underwent Ch-EVAR to reconstruct 28 branching arteries (20 renal arteries and 1 superior mesenteric artery). Postoperative the type Ia endoleak was 13% which were satisfactory and consistent with the results reported internationally. 18–20 . Meanwhile the long-term follow-up results of our center showed that the patency rate of chimney stent was 100%, which may be related to our adherence to long-term postoperative antiplatelet therapy. This study was a retrospective study, and there was some bias in case selection. The heterogeneity of patient basic condition, diagnosis and lesion range interfered with the results to some extent. The patient of the Ch-EVAR is relatively small, and the evaluation of the outcome is not comprehensive, and the long-term follow-up results need to be further confirmed. CONCLUSION The off-label use of S-EVAR for JAAA, with a straight and 8–10 mm aortic neck length, can be considered safe and effective. Ch-EVAR is more suitable for JAAA with excessive twisting of the neck (suprarenal aortic angle < 114°). In this study, long-term data of both technologies showed satisfactory results in preventing aneurysm rupture and the related mortality. Abbreviations EVAR endovascular aneurysm repair OSR open surgical repair AAA abdominal aortic aneurysms ESVS European Society for Vascular Surgery JAAA juxtarenal abdominal aortic aneurysm S-EVAR standard grafting Ch-EVAR chimney grafting CTA computed tomography angiography FEV1 forced expiratory volume in the first second FVC forced vital capacity ICU Intensive care unit. Declarations Acknowledgements: Not applicable. Author contributions: Yu Zhou and Zuojun Hu had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Mingshan Wang, Huoying Cai and Zhen Liu. Acquisition, analysis, or interpretation of data: Mingshan Wang, Zhen Liu, Huoying Cai, Lin Huang, Ruiming Liu, Siwen Wang, Yuansen Qin, Jin Cui. Drafting of the manuscript: Mingshan Wang, Zhen Liu. Critical revision of the manuscript for important intellectual content: Yu Zhou, Zuojun Hu. Statistical analysis: Mingshan Wang, Zhen Liu, Huoying Cai, Yu Zhou. Administrative, technical, or material support: Jinsong Wang, Guangqi Chang, Chen Yao, Shenming Wang, Yu Zhou, Zuojun Hu. Supervision: Yu Zhou, Zuojun Hu. All authors read and approved the final manuscript. Mingshan Wang, Huoying Cai and Zhen Liu contributed equally to this article and share co-first authorship. Funding: The authors received no specifc funding for this work. Availability of data and materials ： The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Declarations Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and was approved by the Independent Ethics Committee for Clinical Research and Animal Trials of the First Affiliated Hospital of Sun Yat-sen University at the commencement of this study, with an exemption from informed consent. All methods were performed in accordance with the relevant guidelines and regulations. Consent for publication: The patients gave permission for the publication of this study. Competing interests: The authors declare that they have no competing interests. References Cerini P, Guzzardi G, Divenuto I, Parziale G, Brustia P, Carriero A, et al. Are abdominal aortic aneurysms with hostile neck really unsuitable for EVAR? Our experience. Radiol Med. 2016;121:528–35. Stather PW, Sayers RD, Cheah A, Wild JB, Bown MJ, Choke E. Outcomes of endovascular aneurysm repair in patients with hostile neck anatomy. Eur J Vasc Endovasc Surg. 2012;44:556–61. Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, et al. editors. 's Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8–93. 10.1016/j.ejvs.2018.09.020 . Jongkind V, Yeung KK, Akkersdijk GJ, Heidsieck D, Reitsma JB, Tangelder GJ, et al. Juxtarenal aortic aneurysm repair. J Vasc Surg. 2010;52:760–7. 10.1016/j.jvs.2010.01.049 . Epub 2010 Apr 10. PMID:20382492. Sobocinski J, Resch T, Midulla M, Maurel B, Guillou M, Azzaoui R, et al. Fenestrated and branched technology: what’s new? J Cardiovasc Surg (Torino). 2012;53(suppl 1):73–81. Greenberg RK, Clair D, Srivastava S, Bhandari G, Turc A, Hampton J, et al. Should patients with challenging anatomy be offered endovascular aneurysm repair? J Vasc Surg. 2003;38:990–6. Hogendoorn W, Schlösser FJ, Moll FL, Sumpio BE, Muhs BE. Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg. 2013;58:502–11. 10.1016/j. jvs.2013.03.043. Greenberg RK, Clair D, Srivastava S, Bhandari G, Turc A, Hampton J, et al. Should patients with challenging anatomy be offered endovascular aneurysm repair? J Vasc Surg. 2003;38:990–6. Freyrie A, Gargiulo M, Gallitto E, Faggioli GL, Testi G, Giovanetti F, et al. Abdominal aortic aneurysms with short proximal neck: comparison between standard endograft and open repair. J Cardiovasc Surg. 2012;53:617–23. Banno H, Cochennec F, Marzelle J, Becquemin JP. Comparison of fenestrated endovascular aneurysm repair and chimney graft techniques for pararenal aortic aneurysm. J Vasc Surg. 2014;60:31–9. 10.1016/j.jvs.2014.01.036 . Chaikof EL, Fillinger MF, Matsumura JS, Rutherford RB, White GH, Blankensteijn JD, et al. Identifying and grading factors that modify the outcome of endovascular aortic aneurysm repair. J Vasc Surg. 2002;35:1061–6. Moulakakis KG, Mylonas SN, Avgerinos E, Papapetrou A, Kakisis JD, Brountzos EN, et al. The chimney graft technique for preserving visceral vessels during endovascular treatment of aortic pathologies. J Vasc Surg. 2012;55:1497–503. 10.1016/j.jvs.2011.10.009 . Donas KP, Torsello GB, Piccoli G, Pitoulias GA, Torsello GF, Bisdas T, et al. The Protagoras study to evaluate the performance of the Endurant stent graft for patients with pararenal pathologic processes treated by the chimney/snorkel endovascular technique. J Vasc Surg. 2016;63:1–7. Greenberg R, Fairman R, Srivastava S, Criado F, Green R. Endovascular grafting in patients with short proximal necks: an analysis of short-term results. Cardiovasc Surg. 2000;8:350–4. Gallitto E, Gargiulo M, Freyrie A, Bianchini Massoni C, Pini R, Mascoli C, Faggioli G, Stella A. Results of standard suprarenal fixation endografts for abdominal aortic aneurysms with neck length ≤ 10mm in high-risk patients unfit for open repair and fenestrated endograft. J Vasc Surg. 2016;64(3):563–570e1. Matsagkas M, Kouvelos G, Peroulis M, Avgos S, Arnaoutoglou E, Papa N, et al. Standard endovascular treatment of abdominal aortic aneurysms in patients with very short proximal necks using the Endurant stent graft. J Vasc Surg. 2015;61:9–15. Katsargyris A, Marques de Marino P, Mufty H, Pedro LM, Fernandes R, Verhoeven EL. Early Experience with the Use of Inner Branches in Endovascular Repairof Complex Abdominal and thoracoabdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg. 2018;55:640–6. 10.1016/j. ejvs.2018.01. Ferrari E, Wang C, Berdajs D, von Segesser LK. Chimney grafts in renal arteries: a clinical model for coronary perfusion in future transcatheter aortic root repair techniques. J Cardiothorac Surg. 2020;15:132. 10.1186/s13019-020-01184-1 . Pitoulias GA, Torsello G, Austermann M, Pitoulias AG, Pipitone MD, Fazzini S, et al. Outcomes of elective use of the chimney endovascular technique in pararenal aortic pathologic processes. J Vasc Surg. 2021;73:433–42. 10.1016/j.jvs.2020.05.029 . Ullery BW, Lee JT, Dalman RL. Snorkel/chimney and fenestrated endografts for complex abdominal aortic aneurysms. J Cardiovasc Surg (Torino). 2015;56:707–17. Tables Table I. Clinical data Variable S-EVAR (n=62) Ch-EVAR (n=23) p-value Age, years 72.1±7.3 72.3±7.5 0.949 Male, n (%) 57 (91.9) 16 (69.6) 0.023 Underlying disease, n (%) Hypertension 40 (64.5) 16 (69.6) 0.663 Coronary heart disease 15 (24.2) 6 (26.1) 0.857 Diabetes 6 (9.7) 2 (8.7) 1.000 Renal insufficiency 1.000 CKD1 0 (0.0) 0 (0.0) — CKD2 1 (1.6) 0 (0) 1.000 CKD3 2 (3.2) 1 (4.3) 1.000 CKD4 1 (1.6) 0 (0) 1.000 CKD5 1 (1.6) 0 (0) 1.000 Peripheral vascular disease 2 (3.2) 1 (4.3) 1.000 COPD 6 (9.7) 0 (0) 0.184 Cancer 4 (6.5) 4 (17.4) 0.264 Smoking 37 (59.7) 1 (4.3) <0.001 Drinking 10 (16.1) 13 (56.5) <0.001 Numbers indicate n (%) or mean ± standard deviation. EVAR: endovascular aneurysm repair, S: standard, Ch: chimney, COPD: chronic obstructive pulmonary disease, CKD: chronic kidney disease Table II. Abdominal aortic aneurysm anatomic data Variable S-EVAR (n=62) Ch-EVAR (n=23) p-value Aortic aneurysm length, mm 110.4±30.9 124±22.3 0.058 Aortic aneurysm diameter, mm 57.2±15.9 65.4±12.1 <0.05 Aortic neck diameter, mm 26.05±0.49 27.49±0.78 0.124 Aortic neck length, mm 8.09±0.12 5.9±0.34 <0.001 Aortic neck angle (α), ° 162.9±26 149.5±29.6 0.045 Aortic neck angle (β), ° 144.1±31 119.5±31.6 <0.001 Conical neck, n (%) 14 (22.6) 3 (13) 0.502 Calcification/thrombus, n (%) 5 (8.1) 1 (4.3) 1.000 Common iliac artery involvement, n (%) 0.649 Unilateral 10 (16.1) 2 (8.7) Bilateral 21 (33.9) 8 (34.8) External iliac artery involvement, n (%) 0.617 Unilateral 1 (1.6) 1 (4.3) Bilateral 1 (1.6) 0 (0) Internal iliac artery involvement, n (%) 0.735 Unilateral 8 (12.9) 2 (8.7) Bilateral 6 (9.7) 1 (4.3) Numbers indicate n (%) or mean ± standard deviation. EVAR: endovascular aneurysm repair, S: standard, Ch: chimney Table III. The effect of different brand stents on type Ia endoleak in S-EVAR and Ch-EVAR Brand S-EVAR (n=62) Ch-EVAR (n=23) Gore 2/10 (3.2) 2/12 (8.7) Medtronic 4/39 (6.5) 1/10 (4.3) Optimed 0/1 (0) - Huaimai Taike 0/11 (0) 0/1 (0) MicroPort Endovascular 0/1 (0) - p-value 0.588 1.000 Numbers indicate n (%). EVAR: endovascular aneurysm repair, S: standard, Ch: chimney Table IV. Intraoperative and hospitalization-related data Variable S-EVAR (n=62) Ch-EVAR (n=23) p-value Anesthetic time (min) 177.5(80,730) 300(160,720) <0.001 Operative time (min) 122.5(55,700) 220(120,635) <0.001 Intraoperative bleeding (mL) 50(5,1000) 100(10,800) <0.001 Blood transfusion (mL) 0(0,920) 0(0,1320) 0.497 Hospitalization time (days) 12(5,37) 17(7,34) 0.016 ICU monitoring time (days) 0(0,7) 1(0,6) 0.013 Numbers indicate the median (min, max). EVAR: endovascular aneurysm repair, S: standard, Ch: chimney Table V. Perioperative events Variable S-EVAR (n=62) Ch-EVAR (n=23) p-value Perioperative death, n (%) 1 (1.6) 0 (0) 1.000 Perioperative reoperation, n (%) 2 (3.2) 3 (13) 0.113 Perioperative operative complications, n (%) Heart 0 (0) 2 (8.7) 0.071 Brain 1 (1.6) 0 (0) 1.000 Lung 0 (0) 0 (0) — Kidney CKD1 0 (0) 0 (0) — CKD2 0 (0) 0 (0) — CKD3 1 (1.6) 0 (0) 1.000 CKD4 0 (0) 0 (0) — CKD5 0 (0) 0 (0) — Liver 0 (0) 0 (0) — Intestine 0 (0) 0 (0) — MODS 0 (0) 0 (0) — Bleeding 2 (3.2) 1 (4.3) 1.000 Endoleak 0.019 Ia 3(4.8) 3 (13) 0.295 Ib 1 (1.6) 0 (0) 1.000 II 2 (3.2) 2 (8.7) 0.295 III 1 (1.6) 2 (8.7) 0.177 IV 0 (0) 0 (0) — Stent migration/ fracture 0 (0) 0 (0) — Stent graft infections 0 (0) 0 (0) — Limb graft occlusion 1 (1.6) 1 (4.3) 0.470 Other 3 (4.8) 1 (4.3) 1.000 Numbers indicate n (%). EVAR: endovascular aneurysm repair, S: standard, Ch: chimney, CKD: chronic kidney disease, MODS: multiple organ dysfunction syndrome Table VI. Date of chimney grafts usage and reconstruction of branching arteries No. (%) Reconstructed renal arteries left renal artery 12(52.2) right renal artery 7(30.4) bilateral renal artery 4(17.4) Reconstructed SMA 1(4.3) Chimney grafts Viabhan (Gore，USA), 17(73.9) Omnilink Elite (Abbott，USA) 1(4.3) Absolute (Abbott，USA) 1(4.3) Protege GPS (EV3,USA) 1(4.3) Pulsar-18 (BioTronic, German) 3(13) Innova（Boston Scientific, USA） 1(4.3) SMA: superior mesenteric artery Table VII. Follow-up mortality and morbidity Variable S-EVAR (n=62) Ch-EVAR (n=23) p-value Follow-up period death, n (%) 17 (27.4) 9 (39.1) 0.298 Follow-up period reoperation, n (%) 5 (9.7) 2 (8.7) 1.000 Follow-up period operative complications, n (%) Heart 1 (1.6) 0 (0) 1.000 Brain 1 (1.6) 1 (4.3) 0.470 Lung 0 (0) 0 (0) — Kidney 1.000 CKD1 0 (0) 0 (0) — CKD2 1 (1.6) 0 (0) 1.000 CKD3 2 (3.2) 0 (0) 1.000 CKD4 2 (3.2) 1 (4.3) 1.000 CKD5 2 (3.2) 1 (4.3) 1.000 Liver 0 (0) 0 (0) — Intestine 0 (0) 0 (0) — Endoleak 0.192 Ia 3 (4.8) 0(0) 0.083 Ib 1 (1.6) 2 (8.7) 0.177 II 2 (3.2) 3 (13) 0.120 III 0 (0) 0 (0) — IV 0 (0) 1 (4.3) 0.271 Stent migration/fracture 0 (0) 0 (0) — Stent graft infections 1 (1.6) 0 (0) 1.000 Limb graft occlusion 1 (1.6) 0 (0) 1.000 Other 1 (1.6) 0 (0) 1.000 Numbers indicate n (%). EVAR: endovascular aneurysm repair, S: standard, Ch: chimney, CKD: chronic kidney disease Table VIII. Analysis of factors related to Ia endoleak in S-EVAR Univariate Multivariate Variable OR 95%CI P OR 95%CI P Aortic neck diameter 2.43 1.04–5.26 0.039 - - - Aortic neck length 1.71 0.58–5.05 0.328 - - - Aortic neck angle (α) 0.97 0.94–0.99 0.016 0.97 0.94–0.99 0.016 Aortic neck angle (β) 0.96 0.93–1 0.042 - - - Conical neck 1.83 0.3–11.24 0.512 - - - Calcification/thrombus 2.60 0.24–27.98 0.431 - - - CI: confidence interval, OR: odds ratio Table IX. Analysis of factors related to Ia endoleak in Ch-EVAR Univariate Multivariate Variable OR 95%CI P OR 95%CI P Aortic neck diameter 0.75 0.52–1.07 0.116 - - - Aortic neck length 1.22 0.63–2.34 0.561 - - - Aortic neck angle (α) 1.02 0.97–1.08 0.391 - - - Aortic neck angle (β) 1.02 0.98–1.06 0.324 - - - Conical neck - - 1 - - - Calcification/thrombus - - 1 - - - CI: confidence interval, OR: odds ratio Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3800230","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":263275619,"identity":"5773f3b1-b0cf-4d97-ad9c-5cba56c3682d","order_by":0,"name":"Mingshan Wang","email":"","orcid":"","institution":"Sun Yat-Sen University","correspondingAuthor":false,"prefix":"","firstName":"Mingshan","middleName":"","lastName":"Wang","suffix":""},{"id":263275620,"identity":"f7bbce10-c269-428d-9dea-46dd26c7fd1d","order_by":1,"name":"Huoying Cai","email":"","orcid":"","institution":"Sun Yat-Sen University","correspondingAuthor":false,"prefix":"","firstName":"Huoying","middleName":"","lastName":"Cai","suffix":""},{"id":263275621,"identity":"140332e9-3e1b-456c-a513-c9b861909c71","order_by":2,"name":"Zhen Liu","email":"","orcid":"","institution":"Gansu Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhen","middleName":"","lastName":"Liu","suffix":""},{"id":263275622,"identity":"4c0833a4-ba71-4c66-ae90-abbf1d2962f4","order_by":3,"name":"Lin Huang","email":"","orcid":"","institution":"Sun Yat-Sen University","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Huang","suffix":""},{"id":263275623,"identity":"c78c3d6b-13fd-414a-841f-61a7574ddce5","order_by":4,"name":"Ruiming Liu","email":"","orcid":"","institution":"Sun Yat-Sen University","correspondingAuthor":false,"prefix":"","firstName":"Ruiming","middleName":"","lastName":"Liu","suffix":""},{"id":263275624,"identity":"b7afaa12-8058-478d-bc0c-88a58eccbb1a","order_by":5,"name":"Siwen Wang","email":"","orcid":"","institution":"Sun Yat-Sen University","correspondingAuthor":false,"prefix":"","firstName":"Siwen","middleName":"","lastName":"Wang","suffix":""},{"id":263275625,"identity":"8016c655-8da9-4d12-8e78-985452e0759b","order_by":6,"name":"Yuansen Qin","email":"","orcid":"","institution":"Sun Yat-Sen University","correspondingAuthor":false,"prefix":"","firstName":"Yuansen","middleName":"","lastName":"Qin","suffix":""},{"id":263275626,"identity":"f5030a91-c489-45ca-9dc6-c0dd8d716f0c","order_by":7,"name":"Jin Cui","email":"","orcid":"","institution":"Sun Yat-Sen University","correspondingAuthor":false,"prefix":"","firstName":"Jin","middleName":"","lastName":"Cui","suffix":""},{"id":263275627,"identity":"be6bef21-8ca9-40d9-8ab1-a1d99668544c","order_by":8,"name":"Guangqi Chang","email":"","orcid":"","institution":"Sun Yat-Sen University","correspondingAuthor":false,"prefix":"","firstName":"Guangqi","middleName":"","lastName":"Chang","suffix":""},{"id":263275628,"identity":"6cd8fca2-e58a-4edc-9c2f-0bec832ae841","order_by":9,"name":"Chen Yao","email":"","orcid":"","institution":"Sun Yat-Sen University","correspondingAuthor":false,"prefix":"","firstName":"Chen","middleName":"","lastName":"Yao","suffix":""},{"id":263275629,"identity":"efa0b412-a33f-4b98-8594-b8a81ea60c92","order_by":10,"name":"Shenming Wang","email":"","orcid":"","institution":"Sun Yat-Sen University","correspondingAuthor":false,"prefix":"","firstName":"Shenming","middleName":"","lastName":"Wang","suffix":""},{"id":263275631,"identity":"5e0beaa7-85da-43e1-af93-5b8cd992e192","order_by":11,"name":"Jinsong Wang","email":"","orcid":"","institution":"Guangdong Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jinsong","middleName":"","lastName":"Wang","suffix":""},{"id":263275632,"identity":"c0507522-a0db-4a8e-8267-94712dfa75b0","order_by":12,"name":"Yu Zhou","email":"","orcid":"","institution":"Sun Yat-Sen University","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Zhou","suffix":""},{"id":263275633,"identity":"a9b9758c-f001-44db-9bd2-b31650e3d15f","order_by":13,"name":"Zuojun Hu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCElEQVRIiWNgGAWjYBACAzDJw8DAD6QOPIAJ8xCjRbIBqCWBeC0gxgEgQZQWc4n0ZxIfZA7nGV87/BBoS13i/BkJjA/etjHIm+PQYjkjIU1yBs/hYrPbaQZALYcTN9xIYDac28ZguLMBh8NuJByT5uE5nLjtdgJIy4HEDRIJbNK8bQwJYKdi1ZLYBtayeXb6B5jD2H/j15LMBtayQToHZAtzYsONBDZmvFrOPGO2nMGTnjjjdk7BgQSDw8YbzjxslpxzTsJwAy4tx9Mf3vjYY53YPzt984cPFXWy89uTD354U2Yjj8sWMGDsgZvA4NjAwNgAZEngUQ8CPxBMewJKR8EoGAWjYAQCAG0LYShEoh+gAAAAAElFTkSuQmCC","orcid":"","institution":"Sun Yat-Sen University","correspondingAuthor":true,"prefix":"","firstName":"Zuojun","middleName":"","lastName":"Hu","suffix":""}],"badges":[],"createdAt":"2023-12-24 11:44:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3800230/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3800230/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49072874,"identity":"8757d4f1-0b9f-41dd-9fe1-6505af3759a1","added_by":"auto","created_at":"2024-01-02 17:21:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":49520,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3800230/v1/af07d93a1d7010974591fe58.png"},{"id":56837031,"identity":"f15e533d-c757-4dba-a601-32d5b0f2c453","added_by":"auto","created_at":"2024-05-21 06:16:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":926683,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3800230/v1/0f9bc4bd-8c9f-47fe-b656-f660996b8844.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of standard endovascular repair and chimney graft for juxtarenal abdominal aortic aneurysm","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEndovascular aneurysm repair (EVAR) has gradually taken over from open surgical repair (OSR) for the repair of abdominal aortic aneurysms (AAA) because mortality and complication rates of EVAR are significantly lower than with OSR.\u003csup\u003e1,2\u003c/sup\u003e However, EVAR is not indicated in certain AAA patients because of unsuitable anatomical characteristics. The ESVS guidelines define JAAA as an abdominal aneurysm with a short neck (\u0026lt;\u0026thinsp;10mm) but not involving the renal arteries.\u003csup\u003e3\u003c/sup\u003e JAAA accounts for approximately 15% of all AAA.\u003csup\u003e4\u003c/sup\u003e According to the instructions for use (IFU)of the majority of manufacturers, the JAAA owe to its short neck ༜10 mm not be suitable for standard EVAR (S-EVAR). Therefore, many techniques, such as fenestrated and branch stent technologies, have been used for endovascular treatment. However, the applicability of these techniques is limited by the anatomical characteristics of the neck, high costs, and lengthy manufacturing lead times.\u003csup\u003e5\u003c/sup\u003e Therefore, those techniques are unsuitable for emergency treatment of a ruptured JAAA.\u003c/p\u003e \u003cp\u003eGreenberg et al.\u003csup\u003e6\u003c/sup\u003e first used renal stents combined with an aortic stent graft to treat JAAA. This technique does not need to be customized and can be combined with conventional stents according to a patient\u0026rsquo;s specific requirement. Chimney EVAR (Ch-EVAR) has since become widely used in clinical practice. However, due to the \u0026ldquo;gutters\u0026rdquo; located between the aorta and the stent graft, the risk of a type Ia endoleak is relatively high, and the endoleak incidence rate continues to rise with increasing numbers of reconstructed visceral vessels. The reported perioperative endoleak incidence rate of Ch-EVAR is \u0026gt;\u0026thinsp;14%.\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSome authors suggested using off-label standard stents to treat JAAA in patients who are unfit for OR.\u003csup\u003e8\u003c/sup\u003e Few papers have reported the early clinical results with small cohorts of S-EVAR for JAAA.\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eUntil now, no retrospective series have compared S-EVAR and Ch-EVAR for JAAA. Therefore, this study aimed to compare the clinical outcomes of S-EVAR and Ch-EVAR for JAAA.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cb\u003ePatients.\u003c/b\u003e All consecutive patients with JAAA were treated with S-EVAR or Ch-EVAR between January 2015 and December 2021 in a tertiary vascular unit (Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China). This research follows the principles outlined in the Declaration of Helsinki and informed consent was obtained from all participants. Ethical approval for this study was obtained from the Independent Ethics Committee for Clinical Research and Animal Trials of the First Affiliated Hospital of Sun Yat-sen University at the commencement of this study.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion criteria.\u003c/b\u003e JAAA including short-necked infrarenal (\u0026lt;\u0026thinsp;10 mm) and juxtarenal. The choice between S-EVAR and Ch-EVAR was determined by clinical and anatomic characteristics. Patients who required reconstruction of branch vessel were considered to be treated by Ch-EVAR.\u003c/p\u003e \u003cp\u003e \u003cb\u003eExclusion criteria.\u003c/b\u003e (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) ruptured or near-ruptured JAAA requiring emergency surgery, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) AAA caused by inflammation, infection, or other causes, and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) aortic pseudoaneurysm or dissection.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePreoperative assessment.\u003c/b\u003e All patients were assessed by performing computed tomography angiography (CTA) and ultrasonography preoperatively.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDefinitions\u003c/strong\u003e \u003cp\u003eChronic obstructive pulmonary disease was defined as FEV1/FVC\u0026thinsp;\u0026lt;\u0026thinsp;70%. Hypertension, coronary heart disease and diabetes were identified in patients receiving medical treatment for these conditions. Renal function was graded according to serum creatinine values from I to V (I: \u0026lt;133 mmol/L, II: 133\u0026ndash;177 mmol/L, III: 177\u0026ndash;443 mmol/L, IV: 443\u0026ndash;707 mmol/L, V: \u0026gt;707 mmol/L). Renal insufficiency refers to serum creatinine values\u0026thinsp;\u0026gt;\u0026thinsp;133 mmol/L.\u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe α neck angle was defined as the angle between the suprarenal aortic and the infrarenal neck. The β neck angle was defined as the angle between infrarenal neck and the aneurysm. Severe calcification or thrombosis was defined as \u0026ge;\u0026thinsp;50% of the neck circumference according to the study by Chaikof et al.\u003csup\u003e11\u003c/sup\u003e The conical neck was defined as being within 10 mm below the level of the renal artery, with the abdominal aorta diameter dilated\u0026thinsp;\u0026ge;\u0026thinsp;2 mm.\u003c/p\u003e \u003cp\u003e \u003cb\u003eS-EVAR procedure.\u003c/b\u003e The patient was placed in the supine position under general anesthesia, a longitudinal incision was made at the pulsating femoral arteries on both sides of the groin, the femoral arteries were punctured using the Seldinger method. Digital subtraction angiography was performed to determine anatomical characteristics, and the origin of major branches of the abdominal aorta. In combination with the preoperative imaging examination, this allowed the corresponding specification of the covered stent to be selected, and the main stent was delivered slowly to the proximal neck anchoring area through the femoral artery. After cannulation of the contralateral iliac gate, the iliac limb was inserted through the opposite side of the guidewire and deployed. Angiography was performed again to identify a potential endoleak. If an Ia endoleak was found, balloon dilation optimized the sealing of the endograft. If there is a still significant Ia endoleak after balloon dilation, we will insert chimney stents to extend proximal anchoring area and cuff was implanted proximal to the main stent to eliminate the Ia endoleak. The main stents used were the Endurant (Medtronic, Minneapolis, MN, USA), Excluder (Gore Medical, Flagstaff, AZ, USA), Sinus XL (Optimed Medical Instruments GmbH, Ettlingen, Germany), Huamai Tianzhuo (Huaimai Taike Medical Device Co., Ltd., Beijing, China), and Minos (MicroPort Endovascular MedTech Group Co., Ltd., Shanghai, China). The oversizing used for the main stent was between 20% and 30%, according to the neck diameter and angles. The most frequently used stent design in the S-EVAR group was a Endurant (Medtronic, USA) (39 of 62).\u003c/p\u003e \u003cp\u003e \u003cb\u003eCh-EVAR procedure.\u003c/b\u003e This was performed as for the S-EVAR, but we used a left brachial artery approach and inserted chimney stents before delivering the main aortic stent. Chimney stents include: Viabhan (Gore, USA), Omnilink Elite (Abbott, USA), Absolute (Abbott, USA), Protege GPS (EV3,USA), Innova(Boston Scientific, USA), Pulsar-18 (BioTronic, German). The most frequently used chimney stent was a Viabhan (Gore, USA) (17 of 23). The chimney grafts usage data are presented in table III\u003c/p\u003e \u003cp\u003e \u003cb\u003eFollow-up protocol.\u003c/b\u003e CTA and ultrasonography of the aorta were performed before discharge, at 6 and 12 months postoperatively, and annually thereafter.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStatistical analysis.\u003c/b\u003e Statistical evaluation was performed using SPSS software version 23 (IBM Corp., Armonk, NY, USA). When appropriate, categorical variables were analyzed using the chi-squared test or Fisher\u0026rsquo;s exact test; continuous variables were analyzed using the Student\u0026rsquo;s t-test or Mann\u0026ndash;Whitney U test. Time-to-event analysis was performed using Kaplan\u0026ndash;Meier curves for overall survival. Logistic regression was used to analyze the relationship between anatomical characteristics of the neck and complications. The p-values were then determined; the significance level was p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eThe Yoden index was used to calculate the critical value of the proximal neck angulation. The Yoden index\u0026thinsp;=\u0026thinsp;\u003cem\u003esensitivity\u0026thinsp;+\u0026thinsp;specificity \u0026ndash; 1\u003c/em\u003e, ranging from 0 to 1. The greater the Yoden index, the better the effect of the screening test; the critical diagnostic value of this method is the value of the test variable corresponding to its maximum value.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e \u003cb\u003ePatient characteristics.\u003c/b\u003e A total of 85 patients were enrolled: 63 patients (57 of whom were men) underwent S-EVAR and 23 (16 men) underwent Ch-EVAR. The demographic characteristics and underlying diseases of the patients are detailed in Table I. The proportion of men who underwent S-EVAR (91.9%, 57/62) was greater compared with the proportion who underwent Ch-EVAR (69.6%, 16/23) (p\u0026thinsp;=\u0026thinsp;0.023). In addition, significant differences were found between the S-EVAR group and Ch-EVAR group in smoking (59.7% vs 4.3%) and alcohol consumption (16.1% vs 56.5%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). However, differences between the two groups in age and underlying diseases were not significant.\u003c/p\u003e \u003cp\u003e \u003cb\u003eJAAA anatomic data.\u003c/b\u003e In S-EVAR and Ch-EVAR groups, the neck length (8.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12 vs 5.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3 mm), neck diameter ((26.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49 vs 27.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78 mm), aneurysm diameter (57.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.9 vs 65.4\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1 mm), suprarenal angle (162.9\u0026thinsp;\u0026plusmn;\u0026thinsp;26\u0026deg; vs 149.5\u0026thinsp;\u0026plusmn;\u0026thinsp;29.6\u0026deg;), infrarenal angle (144.1\u0026thinsp;\u0026plusmn;\u0026thinsp;31\u0026deg; vs 119.5\u0026thinsp;\u0026plusmn;\u0026thinsp;31.6\u0026deg;). The anatomical data for JAAA are shown in Table II.\u003c/p\u003e \u003cp\u003e \u003cb\u003eIntraoperative stent usage\u003c/b\u003e. The stents used in this study were the Endurant (Medtronic, Minneapolis, MN, USA), Excluder (Gore Medical, Flagstaff, AZ, USA), Sinus XL (Optimed Medical Instruments GmbH, Ettlingen, Germany), Huamai Tianzhuo (Huaimai Taike Medical Device Co., Ltd., Beijing, China), and Minos (MicroPort Endovascular MedTech Group Co., Ltd., Shanghai, China). The analysis indicated no significant differences in the incidence of type Ia endoleak in different main body endograft brands (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The effects of different brands of stents on type Ia endoleak in S-EVAR and Ch-EVAR are listed in table III\u003c/p\u003e \u003cp\u003e \u003cb\u003eIntraoperative and hospitalization-related data.\u003c/b\u003e Intraoperative and hospitalization-related data are presented in table IV. The S-EVAR group was superior to the Ch-EVAR in terms of hospitalization time, ICU monitoring time, operation time, anesthesia time, and perioperative bleeding (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cb\u003ePerioperative events\u003c/b\u003e. The perioperative events are listed in Table V. In S-EVAR there were three (4.8%) type Ia endoleak. One underwent conversion to OR for AAA rupture at 7 days and died (1/62, 1.6% proximal neck -related mortality). Two were follow-up observations due to minor type Ia endoleak. Among them, one sealed by endovascular repair at 12 months and another one continued observing. Another one (1.6%) patient was performed reintervention (Iliac leg extension) due to type Ib endoleak at 3 days.\u003c/p\u003e \u003cp\u003eIn Ch-EVAR there were three (13%) type Ia endoleak. All of them were follow-up observations in view of minor type Ia endoleak. Among them, one sealed by endovascular repair at 6 months. Another three (13%) patients were performed reoperation, including a pseudoaneurysm of the left brachial artery at 10 days, a right renal hemorrhage at 7 days and a right femoral artery thrombosis at 1 day. The chimney grafts usage and reconstruction of branching arteries are presented in table VI.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFollow-up mortality and complications\u003c/b\u003e. Follow-up mortality and complications are summarized in Table VII. Median follow-up duration was 48 months, (range, 0\u0026ndash;94 months) in the S-EVAR group and 42 months (range, 0\u0026ndash;90 months) in the Ch-EVAR group.\u003c/p\u003e \u003cp\u003eIn S-EVAR there were three (4.8%) type Ia endoleak. Two were sealed by endovascular repair at 18 and 24 months. One reject reoperation at 36 months. And there were two aneurysm-related deaths in the S-EVAR group; one death was due to a postoperative stent extrusion that led to JAAA rupture at 11month, and one patient died of sepsis due to stent infection 1 month after surgery. There were 5 of 62 (11.3%) reinterventions during follow-up including: 2 type Ia endoleak, 2 type II endoleak, and 1 type Ib endoleak .\u003c/p\u003e \u003cp\u003eNo new type Ia endoleak and aneurysm-related deaths occurred in the Ch-EVAR group. There were 2 of 23 (%) reinterventions during follow-up including: 1 type Ia endoleak, 1 type II endoleak. The patency rate of chimney stent was 100%.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAnalysis of factors related to type Ia endoleak.\u003c/b\u003e The incidence of type Ia endoleak following S-EVAR was negatively associated with the α neck angle. Patients with type Ia endoleak had a smaller α neck angle. The Yoden index calculated a critical value of 114\u0026deg; for the α neck angle in the S-EVAR. When the α neck angle was \u0026lt;\u0026thinsp;114\u0026deg;, the incidence of type Ia endoleak following S-EVAR was significantly higher than that in patients with angles\u0026thinsp;\u0026gt;\u0026thinsp;114\u0026deg;: 50%vs 6.9%, (p\u0026thinsp;=\u0026thinsp;0.005) (Table VIII).\u003c/p\u003e \u003cp\u003eIn contrast, the incidence of type Ia endoleak in the Ch-EVAR was not related to the proximal neck. (Table IX)\u003c/p\u003e \u003cp\u003e \u003cb\u003eSurvival analysis\u003c/b\u003e. The estimated overall survival rates were similar in both groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). S-EVAR 1-year survival rate were 91.9%, 3-year survival rate 81.7%, 5-year survival rate 62.2%, respectively. The Ch-EVAR 1-year survival rate 91.3%, 3-year survival rate 78.7%, 5-year survival rate 45.8%, all lower than those of S-EVAR. But the difference was not statistically significant (P\u0026thinsp;=\u0026thinsp;0.288).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, we compared the perioperative and follow-up results of S-EVAR and Ch-EVAR and found no statistical differences in type Ia endoleak, AAA-related mortality and reoperation.\u003c/p\u003e \u003cp\u003ePerforming Ch-EVAR for the treatment of JAAA was first reported by Greenberg et al.\u003csup\u003e6\u003c/sup\u003e in 2003 and has achieved good results by effectively maintaining the blood supply to the branch artery. Studies have shown that the long-term patency rate of renal artery chimney stents exceeds 97%.\u003csup\u003e12\u003c/sup\u003e In contrast to fenestrated and branch stent technologies, Ch-EVAR does not require customization based on the vascular anatomical characteristics of each patient. They can be combined with conventional stents according to specific patient requirements and are suitable for emergency surgery or AAA patients with perioperative emergencies. They are relatively easy to use and widely used in clinical practice. However, the gap between the chimney stent, main stent, and aortic wall results in a relatively high risk of type Ia endoleak.\u003c/p\u003e \u003cp\u003eThe Protagoras study\u003csup\u003e13\u003c/sup\u003e included 128 patients with 187 implanted chimney stents (160 RA, 15 ARA, 10 SMA, and 2 CA), with a 30-day mortality rate of 0.8%, an average follow-up of 24.6 months, and a type Ia endoleak rate of 1.6%. The primary and secondary intervention rates were 95.7% and 93.1%, respectively. Therefore, postoperative complications, such as type Ia endoleak and renal insufficiency, remain an issue following Ch-EVAR. In addition, Ch-EVAR has certain requirements for the operator\u0026rsquo;s intracavity technology and costs 2\u0026ndash;3 times more than S-EVAR.\u003c/p\u003e \u003cp\u003eWith continuous improvements in endovascular repair instruments and increasing endovascular experience, the surgical indications for S-EVAR have gradually increased. Greenberg et al\u003csup\u003e8,14\u003c/sup\u003e indicateed that challenging aortic anatomy and short proximal neck are not contraindications to EVAR in patients. Recently, Gallitto et al\u003csup\u003e15\u003c/sup\u003e reported that EVAR may be safely performed in JAAA (outside the IFU) by use of suprarenal fixation stents.\u003c/p\u003e \u003cp\u003eMatsagkas et al.\u003csup\u003e16\u003c/sup\u003e compared the clinical effects of the Endurant stent in AAAs with short (\u0026lt;\u0026thinsp;10 mm) and long aneurysm necks. Except for a small aneurysm neck angle in the short aneurysm neck group, no type I endoleak was observed in either group during the follow-up period. Furthermore, no significant differences were found between the two groups for secondary intervention or aneurysm-related mortality. This finding indicates that even if the patient\u0026rsquo;s aneurysm neck length is less than 10 mm, as long as the aneurysm neck is not too twisted, an Endurant stent can achieve good clinical results.\u003c/p\u003e \u003cp\u003eThe advantage of one technique over another is unclear because of the scarcity of reports comparing these two techniques. The most relevant reports are on the short- and long-term effects of S-EVAR and Ch-EVAR, respectively; comparative studies between the two surgical methods are lacking.\u003c/p\u003e \u003cp\u003eTherefore, current evidence is insufficient for determining which is the most appropriate method for the treatment of JAAA. Some experts may choose Ch-EVAR because of its theoretical superiority; others may prefer S-EVAR to avoid potential technical difficulties and type Ia endoleaks. At our institution, most patients who undergo S-EVAR have longer neck lengths, smaller neck diameters and bigger suprarenal or infrarenal aortic angles. This study aimed to provide data to aid in deciding between S-EVAR and Ch-EVAR for the treatment of JAAA.\u003c/p\u003e \u003cp\u003eIn this study, all early- and long-term analyses showed no significant difference in the rate of AAA-related mortality, type Ia endoleak and reoperation between the two groups despite (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) smaller suprarenal and infrarenal aortic angles in Ch-EVAR, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) longer neck length in the S-EVAR group.\u003c/p\u003e \u003cp\u003eIn our study, S-EVAR had advantages over Ch-EVAR in terms of hospitalization time, ICU monitoring time, operative time, anesthesia time, and perioperative bleeding. Therefore, S-EVAR is a safe and effective treatment method for patients with JAAA who are generally poor and have difficulty tolerating a long operation time.\u003c/p\u003e \u003cp\u003eRenal insufficiency is another important factor; the incidence is 1\u0026ndash;23%.\u003csup\u003e17\u003c/sup\u003e Several reasons for postoperative renal insufficiency after EVAR have been suggested: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) renal injury caused by the large amounts of contrast used during surgery, and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) renal ischemia caused by suprarenal fixation or renal artery stent occlusion. In the current study, the incidence of postoperative renal injury in both groups of patients was low (S-EVAR: 12.9%; Ch-EVAR: 8.7%; p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Ch-EVAR may be a better option to prevent renal insufficiency.\u003c/p\u003e \u003cp\u003eCompared with S-EVAR, Ch-EVAR is more suitable for JAAA involving a short neck length (\u0026lt;\u0026thinsp;5 mm) and excessive twisting of the neck (suprarenal aortic angle\u0026thinsp;\u0026lt;\u0026thinsp;114\u0026deg;). In this study, 23 patients underwent Ch-EVAR to reconstruct 28 branching arteries (20 renal arteries and 1 superior mesenteric artery). Postoperative the type Ia endoleak was 13% which were satisfactory and consistent with the results reported internationally.\u003csup\u003e18\u0026ndash;20\u003c/sup\u003e. Meanwhile the long-term follow-up results of our center showed that the patency rate of chimney stent was 100%, which may be related to our adherence to long-term postoperative antiplatelet therapy.\u003c/p\u003e \u003cp\u003eThis study was a retrospective study, and there was some bias in case selection. The heterogeneity of patient basic condition, diagnosis and lesion range interfered with the results to some extent. The patient of the Ch-EVAR is relatively small, and the evaluation of the outcome is not comprehensive, and the long-term follow-up results need to be further confirmed.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe off-label use of S-EVAR for JAAA, with a straight and 8\u0026ndash;10 mm aortic neck length, can be considered safe and effective. Ch-EVAR is more suitable for JAAA with excessive twisting of the neck (suprarenal aortic angle\u0026thinsp;\u0026lt;\u0026thinsp;114\u0026deg;). In this study, long-term data of both technologies showed satisfactory results in preventing aneurysm rupture and the related mortality.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEVAR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eendovascular aneurysm repair\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOSR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eopen surgical repair\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAAA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eabdominal aortic aneurysms\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eESVS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEuropean Society for Vascular Surgery\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eJAAA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ejuxtarenal abdominal aortic aneurysm\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eS-EVAR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003estandard grafting\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCh-EVAR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003echimney grafting\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCTA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecomputed tomography angiography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFEV1\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eforced expiratory volume in the first second\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFVC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eforced vital capacity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensive care unit.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e Yu Zhou and Zuojun Hu had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Mingshan Wang, Huoying Cai and Zhen Liu. Acquisition, analysis, or interpretation of data: Mingshan Wang, Zhen Liu,\u0026nbsp;Huoying Cai, Lin Huang, Ruiming Liu, Siwen Wang, Yuansen Qin, Jin Cui. Drafting of the manuscript: Mingshan Wang, Zhen Liu. Critical revision of the manuscript for important intellectual content:\u0026nbsp;Yu Zhou, Zuojun Hu.\u0026nbsp;Statistical analysis: Mingshan Wang, Zhen Liu,\u0026nbsp;Huoying Cai, Yu Zhou. Administrative, technical, or material support: Jinsong Wang, Guangqi Chang, Chen Yao, Shenming Wang, Yu Zhou, Zuojun Hu. Supervision:\u0026nbsp;Yu Zhou, Zuojun Hu. All authors read and approved the final manuscript. Mingshan Wang, Huoying Cai and Zhen Liu contributed equally to this article and share co-first authorship.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors received no specifc funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch1\u003eDeclarations\u003c/h1\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e The study was conducted in accordance with the Declaration of Helsinki and was approved by the Independent Ethics Committee for Clinical Research and Animal Trials of the First Affiliated Hospital of Sun Yat-sen University at the commencement of this study, with an exemption from informed consent.\u0026nbsp;All methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eThe patients gave permission for the publication of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCerini P, Guzzardi G, Divenuto I, Parziale G, Brustia P, Carriero A, et al. Are abdominal aortic aneurysms with hostile neck really unsuitable for EVAR? Our experience. Radiol Med. 2016;121:528\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStather PW, Sayers RD, Cheah A, Wild JB, Bown MJ, Choke E. Outcomes of endovascular aneurysm repair in patients with hostile neck anatomy. Eur J Vasc Endovasc Surg. 2012;44:556\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, et al. editors. 's Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8\u0026ndash;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ejvs.2018.09.020\u003c/span\u003e\u003cspan address=\"10.1016/j.ejvs.2018.09.020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJongkind V, Yeung KK, Akkersdijk GJ, Heidsieck D, Reitsma JB, Tangelder GJ, et al. Juxtarenal aortic aneurysm repair. J Vasc Surg. 2010;52:760\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jvs.2010.01.049\u003c/span\u003e\u003cspan address=\"10.1016/j.jvs.2010.01.049\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2010 Apr 10. PMID:20382492.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSobocinski J, Resch T, Midulla M, Maurel B, Guillou M, Azzaoui R, et al. Fenestrated and branched technology: what\u0026rsquo;s new? J Cardiovasc Surg (Torino). 2012;53(suppl 1):73\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreenberg RK, Clair D, Srivastava S, Bhandari G, Turc A, Hampton J, et al. Should patients with challenging anatomy be offered endovascular aneurysm repair? J Vasc Surg. 2003;38:990\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHogendoorn W, Schl\u0026ouml;sser FJ, Moll FL, Sumpio BE, Muhs BE. Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg. 2013;58:502\u0026ndash;11. 10.1016/j. jvs.2013.03.043.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreenberg RK, Clair D, Srivastava S, Bhandari G, Turc A, Hampton J, et al. Should patients with challenging anatomy be offered endovascular aneurysm repair? J Vasc Surg. 2003;38:990\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFreyrie A, Gargiulo M, Gallitto E, Faggioli GL, Testi G, Giovanetti F, et al. Abdominal aortic aneurysms with short proximal neck: comparison between standard endograft and open repair. J Cardiovasc Surg. 2012;53:617\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBanno H, Cochennec F, Marzelle J, Becquemin JP. Comparison of fenestrated endovascular aneurysm repair and chimney graft techniques for pararenal aortic aneurysm. J Vasc Surg. 2014;60:31\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jvs.2014.01.036\u003c/span\u003e\u003cspan address=\"10.1016/j.jvs.2014.01.036\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChaikof EL, Fillinger MF, Matsumura JS, Rutherford RB, White GH, Blankensteijn JD, et al. Identifying and grading factors that modify the outcome of endovascular aortic aneurysm repair. J Vasc Surg. 2002;35:1061\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoulakakis KG, Mylonas SN, Avgerinos E, Papapetrou A, Kakisis JD, Brountzos EN, et al. The chimney graft technique for preserving visceral vessels during endovascular treatment of aortic pathologies. J Vasc Surg. 2012;55:1497\u0026ndash;503. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jvs.2011.10.009\u003c/span\u003e\u003cspan address=\"10.1016/j.jvs.2011.10.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonas KP, Torsello GB, Piccoli G, Pitoulias GA, Torsello GF, Bisdas T, et al. The Protagoras study to evaluate the performance of the Endurant stent graft for patients with pararenal pathologic processes treated by the chimney/snorkel endovascular technique. J Vasc Surg. 2016;63:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreenberg R, Fairman R, Srivastava S, Criado F, Green R. Endovascular grafting in patients with short proximal necks: an analysis of short-term results. Cardiovasc Surg. 2000;8:350\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGallitto E, Gargiulo M, Freyrie A, Bianchini Massoni C, Pini R, Mascoli C, Faggioli G, Stella A. Results of standard suprarenal fixation endografts for abdominal aortic aneurysms with neck length\u0026thinsp;\u0026le;\u0026thinsp;10mm in high-risk patients unfit for open repair and fenestrated endograft. J Vasc Surg. 2016;64(3):563\u0026ndash;570e1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatsagkas M, Kouvelos G, Peroulis M, Avgos S, Arnaoutoglou E, Papa N, et al. Standard endovascular treatment of abdominal aortic aneurysms in patients with very short proximal necks using the Endurant stent graft. J Vasc Surg. 2015;61:9\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatsargyris A, Marques de Marino P, Mufty H, Pedro LM, Fernandes R, Verhoeven EL. Early Experience with the Use of Inner Branches in Endovascular Repairof Complex Abdominal and thoracoabdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg. 2018;55:640\u0026ndash;6. 10.1016/j. ejvs.2018.01.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerrari E, Wang C, Berdajs D, von Segesser LK. Chimney grafts in renal arteries: a clinical model for coronary perfusion in future transcatheter aortic root repair techniques. J Cardiothorac Surg. 2020;15:132. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13019-020-01184-1\u003c/span\u003e\u003cspan address=\"10.1186/s13019-020-01184-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePitoulias GA, Torsello G, Austermann M, Pitoulias AG, Pipitone MD, Fazzini S, et al. Outcomes of elective use of the chimney endovascular technique in pararenal aortic pathologic processes. J Vasc Surg. 2021;73:433\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jvs.2020.05.029\u003c/span\u003e\u003cspan address=\"10.1016/j.jvs.2020.05.029\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUllery BW, Lee JT, Dalman RL. Snorkel/chimney and fenestrated endografts for complex abdominal aortic aneurysms. J Cardiovasc Surg (Torino). 2015;56:707\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"96%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable I. Clinical data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\"\u003e\n \u003cp\u003eS-EVAR (n=62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\"\u003e\n \u003cp\u003eCh-EVAR (n=23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\"\u003e\n \u003cp\u003e72.1\u0026plusmn;7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\"\u003e\n \u003cp\u003e72.3\u0026plusmn;7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003e0.949\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eMale, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\"\u003e\n \u003cp\u003e57 (91.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\"\u003e\n \u003cp\u003e16 (69.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eUnderlying disease, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\"\u003e\n \u003cp\u003e40 (64.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\"\u003e\n \u003cp\u003e16 (69.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003e0.663\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eCoronary heart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\"\u003e\n \u003cp\u003e15 (24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\"\u003e\n \u003cp\u003e6 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003e0.857\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\"\u003e\n \u003cp\u003e6 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\"\u003e\n \u003cp\u003e2 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eRenal insufficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eCKD1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eCKD2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\"\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eCKD3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\"\u003e\n \u003cp\u003e2 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eCKD4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\"\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eCKD5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\"\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003ePeripheral vascular disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\"\u003e\n \u003cp\u003e2 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eCOPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\"\u003e\n \u003cp\u003e6 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eCancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\"\u003e\n \u003cp\u003e4 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\"\u003e\n \u003cp\u003e4 (17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003e0.264\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\"\u003e\n \u003cp\u003e37 (59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.996763754045304%\"\u003e\n \u003cp\u003eDrinking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.728155339805824%\"\u003e\n \u003cp\u003e10 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.78640776699029%\"\u003e\n \u003cp\u003e13 (56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.488673139158577%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNumbers indicate n (%) or mean \u0026plusmn; standard deviation. EVAR: endovascular aneurysm repair,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eS: standard, Ch: chimney,\u0026nbsp;COPD: chronic obstructive pulmonary disease, CKD:\u0026nbsp;chronic kidney disease\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable II. Abdominal aortic aneurysm anatomic data\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eS-EVAR (n=62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCh-EVAR (n=23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAortic aneurysm length, mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e110.4\u0026plusmn;30.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e124\u0026plusmn;22.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAortic aneurysm diameter, mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e57.2\u0026plusmn;15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e65.4\u0026plusmn;12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAortic neck diameter, mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26.05\u0026plusmn;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.49\u0026plusmn;0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAortic neck length, mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.09\u0026plusmn;0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.9\u0026plusmn;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAortic neck angle (\u0026alpha;), \u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e162.9\u0026plusmn;26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e149.5\u0026plusmn;29.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAortic neck angle (\u0026beta;), \u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e144.1\u0026plusmn;31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e119.5\u0026plusmn;31.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eConical neck, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.502\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCalcification/thrombus, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCommon iliac artery involvement, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.649\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eUnilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21 (33.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eExternal iliac artery involvement, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.617\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eUnilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eInternal iliac artery involvement, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.735\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eUnilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNumbers indicate n (%) or mean \u0026plusmn; standard deviation.\u0026nbsp;EVAR: endovascular aneurysm repair,\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;S: standard, Ch: chimney\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003cstrong\u003eTable III. The effect of different brand stents on type Ia endoleak in S-EVAR and Ch-EVAR\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"593\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.84822934232715%\"\u003e\n \u003cp\u003eBrand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.436762225969645%\"\u003e\n \u003cp\u003eS-EVAR (n=62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.715008431703204%\"\u003e\n \u003cp\u003eCh-EVAR (n=23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.84822934232715%\"\u003e\n \u003cp\u003eGore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.436762225969645%\"\u003e\n \u003cp\u003e2/10 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.715008431703204%\"\u003e\n \u003cp\u003e2/12 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.84822934232715%\"\u003e\n \u003cp\u003eMedtronic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.436762225969645%\"\u003e\n \u003cp\u003e4/39 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.715008431703204%\"\u003e\n \u003cp\u003e1/10 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.84822934232715%\"\u003e\n \u003cp\u003eOptimed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.436762225969645%\"\u003e\n \u003cp\u003e0/1 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.715008431703204%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.84822934232715%\"\u003e\n \u003cp\u003eHuaimai Taike\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.436762225969645%\"\u003e\n \u003cp\u003e0/11 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.715008431703204%\"\u003e\n \u003cp\u003e0/1 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.84822934232715%\"\u003e\n \u003cp\u003eMicroPort Endovascular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.436762225969645%\"\u003e\n \u003cp\u003e0/1 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.715008431703204%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.84822934232715%\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.436762225969645%\"\u003e\n \u003cp\u003e0.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.715008431703204%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNumbers indicate n (%).\u0026nbsp;EVAR: endovascular aneurysm repair, S: standard, Ch: chimney\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable IV. Intraoperative and hospitalization-related data\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"94%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.0265780730897%\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59800664451827%\"\u003e\n \u003cp\u003eS-EVAR (n=62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.25581395348837%\"\u003e\n \u003cp\u003eCh-EVAR (n=23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.0265780730897%\"\u003e\n \u003cp\u003eAnesthetic time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59800664451827%\"\u003e\n \u003cp\u003e177.5(80,730)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.25581395348837%\"\u003e\n \u003cp\u003e300(160,720)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.0265780730897%\"\u003e\n \u003cp\u003eOperative time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59800664451827%\"\u003e\n \u003cp\u003e122.5(55,700)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.25581395348837%\"\u003e\n \u003cp\u003e220(120,635)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.0265780730897%\"\u003e\n \u003cp\u003eIntraoperative bleeding (mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59800664451827%\"\u003e\n \u003cp\u003e50(5,1000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.25581395348837%\"\u003e\n \u003cp\u003e100(10,800)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.0265780730897%\"\u003e\n \u003cp\u003eBlood transfusion (mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59800664451827%\"\u003e\n \u003cp\u003e0(0,920)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.25581395348837%\"\u003e\n \u003cp\u003e0(0,1320)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e0.497\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.0265780730897%\"\u003e\n \u003cp\u003eHospitalization time (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59800664451827%\"\u003e\n \u003cp\u003e12(5,37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.25581395348837%\"\u003e\n \u003cp\u003e17(7,34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.0265780730897%\"\u003e\n \u003cp\u003eICU monitoring time (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.59800664451827%\"\u003e\n \u003cp\u003e0(0,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.25581395348837%\"\u003e\n \u003cp\u003e1(0,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.119601328903654%\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNumbers indicate the median (min, max).\u0026nbsp;EVAR: endovascular aneurysm repair, S: standard,\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Ch: chimney\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable V.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePerioperative\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;events\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"90%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003eS-EVAR\u003c/p\u003e\n \u003cp\u003e(n=62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003eCh-EVAR\u003c/p\u003e\n \u003cp\u003e(n=23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003ePerioperative death, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003ePerioperative reoperation,\u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e2 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e3 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003ePerioperative operative complications,\u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eHeart\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e2 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eBrain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eLung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eKidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eCKD1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eCKD2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eCKD3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eCKD4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eCKD5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eLiver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eIntestine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eMODS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eBleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e2 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eEndoleak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eIa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e3(4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e3\u0026nbsp;(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e0.295\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eIb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e2 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e2 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e0.295\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e2 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e0.177\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eStent migration/ fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eStent graft infections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eLimb graft occlusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e0.470\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.286701208981%\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.83419689119171%\"\u003e\n \u003cp\u003e3 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.825561312607945%\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.053540587219343%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNumbers indicate n (%).\u0026nbsp;EVAR: endovascular aneurysm repair, S: standard, Ch: chimney,\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;CKD: chronic kidney disease, MODS: multiple organ dysfunction syndrome\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable VI. Date of chimney grafts usage and reconstruction of branching arteries\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.61616161616162%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.38383838383838%\" valign=\"top\"\u003e\n \u003cp\u003eNo. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.61616161616162%\"\u003e\n \u003cp\u003eReconstructed renal arteries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.38383838383838%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.61616161616162%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;left renal artery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.38383838383838%\" valign=\"top\"\u003e\n \u003cp\u003e12(52.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.61616161616162%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;right renal artery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.38383838383838%\" valign=\"top\"\u003e\n \u003cp\u003e7(30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.61616161616162%\"\u003e\n \u003cp\u003ebilateral renal artery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.38383838383838%\" valign=\"top\"\u003e\n \u003cp\u003e4(17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.61616161616162%\" valign=\"top\"\u003e\n \u003cp\u003eReconstructed SMA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.38383838383838%\" valign=\"top\"\u003e\n \u003cp\u003e1(4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.61616161616162%\" valign=\"top\"\u003e\n \u003cp\u003eChimney grafts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.38383838383838%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.61616161616162%\"\u003e\n \u003cp\u003eViabhan (Gore，USA),\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.38383838383838%\" valign=\"top\"\u003e\n \u003cp\u003e17(73.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.61616161616162%\"\u003e\n \u003cp\u003eOmnilink Elite (Abbott，USA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.38383838383838%\" valign=\"top\"\u003e\n \u003cp\u003e1(4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.61616161616162%\"\u003e\n \u003cp\u003eAbsolute (Abbott，USA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.38383838383838%\" valign=\"top\"\u003e\n \u003cp\u003e1(4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.61616161616162%\"\u003e\n \u003cp\u003eProtege GPS (EV3,USA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.38383838383838%\" valign=\"top\"\u003e\n \u003cp\u003e1(4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.61616161616162%\"\u003e\n \u003cp\u003ePulsar-18 (BioTronic, German)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.38383838383838%\" valign=\"top\"\u003e\n \u003cp\u003e3(13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"61.61616161616162%\"\u003e\n \u003cp\u003eInnova（Boston Scientific, USA）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.38383838383838%\" valign=\"top\"\u003e\n \u003cp\u003e1(4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSMA: superior mesenteric artery\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable VII. Follow-up mortality and morbidity\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003eS-EVAR\u003c/p\u003e\n \u003cp\u003e(n=62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003eCh-EVAR\u003c/p\u003e\n \u003cp\u003e(n=23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eFollow-up period death, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e17 (27.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e9 (39.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e0.298\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eFollow-up period reoperation, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e5 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e2 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eFollow-up period operative complications, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eHeart\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eBrain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e0.470\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eLung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eKidney\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eCKD1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eCKD2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eCKD3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e2 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eCKD4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e2 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eCKD5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e2 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eLiver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eIntestine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eEndoleak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eIa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e3 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eIb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e2 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e0.177\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e2 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e3 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e0.271\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eStent migration/fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eStent graft infections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eLimb graft occlusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.48056537102474%\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.487632508833922%\"\u003e\n \u003cp\u003e1 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.547703180212014%\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.484098939929329%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNumbers indicate n (%).\u0026nbsp;EVAR: endovascular aneurysm repair, S: standard, Ch: chimney,\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;CKD: chronic kidney disease\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable VIII. Analysis of factors related to Ia endoleak in S-EVAR\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.714285714285715%\" colspan=\"3\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.061224489795918%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\" colspan=\"3\"\u003e\n \u003cp\u003eMultivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.608695652173914%\"\u003e\n \u003cp\u003eVariable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.304347826086957%\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.695652173913043%\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.57894736842105%\"\u003e\n \u003cp\u003eAortic neck diameter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e2.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e1.04\u0026ndash;5.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.1578947368421053%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.421052631578947%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.608695652173914%\"\u003e\n \u003cp\u003eAortic neck length\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e1.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.304347826086957%\"\u003e\n \u003cp\u003e0.58\u0026ndash;5.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e0.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.695652173913043%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.57894736842105%\"\u003e\n \u003cp\u003eAortic neck angle (\u0026alpha;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e0.94\u0026ndash;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.1578947368421053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.421052631578947%\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e0.94\u0026ndash;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.57894736842105%\"\u003e\n \u003cp\u003eAortic neck angle (\u0026beta;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e0.93\u0026ndash;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.1578947368421053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.421052631578947%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.57894736842105%\"\u003e\n \u003cp\u003eConical neck\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e0.3\u0026ndash;11.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.1578947368421053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.421052631578947%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.57894736842105%\"\u003e\n \u003cp\u003eCalcification/thrombus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e2.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e0.24\u0026ndash;27.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e0.431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.1578947368421053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.421052631578947%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCI: confidence interval, OR: odds ratio\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable IX. Analysis of factors related to Ia endoleak in Ch-EVAR\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.612244897959183%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.714285714285715%\" colspan=\"3\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.061224489795918%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.612244897959183%\" colspan=\"3\"\u003e\n \u003cp\u003eMultivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.608695652173914%\"\u003e\n \u003cp\u003eVariable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.304347826086957%\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.695652173913043%\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.57894736842105%\"\u003e\n \u003cp\u003eAortic neck diameter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e0.52\u0026ndash;1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.1578947368421053%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.421052631578947%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.608695652173914%\"\u003e\n \u003cp\u003eAortic neck length\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.304347826086957%\"\u003e\n \u003cp\u003e0.63\u0026ndash;2.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e0.561\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.695652173913043%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.782608695652174%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.043478260869565%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.57894736842105%\"\u003e\n \u003cp\u003eAortic neck angle (\u0026alpha;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e\u0026nbsp;0.97\u0026ndash;1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e0.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.1578947368421053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.421052631578947%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.57894736842105%\"\u003e\n \u003cp\u003eAortic neck angle (\u0026beta;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e0.98\u0026ndash;1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.1578947368421053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.421052631578947%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.57894736842105%\"\u003e\n \u003cp\u003eConical neck\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.1578947368421053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.421052631578947%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.57894736842105%\"\u003e\n \u003cp\u003eCalcification/thrombus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.789473684210526%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.1578947368421053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.421052631578947%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.473684210526315%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCI: confidence interval, OR: odds ratio\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"abdominal aortic aneurysm, endoleak, endovascular aneurysm repair, postoperative complications, treatment outcome","lastPublishedDoi":"10.21203/rs.3.rs-3800230/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3800230/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study compared the efficacy of standard grafting (S-EVAR) and chimney grafting (Ch-EVAR) for treating juxtarenal abdominal aortic aneurysms(JAAA).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eData of patients with JAAA, who underwent S-EVAR and Ch-EVAR from January 2015 to December 2021 were collected. Follow-up was performed by CTA and ultrasonography of the aorta were performed before discharge, at 6 and 12 months postoperatively, and annually thereafter. Main outcome measures: AAA-related mortality, type Ia endoleak and reoperation\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 62 patients underwent S-EVAR and 23 underwent Ch-EVAR. The proportion of men who underwent S-EVAR (91.9%, 57/62) was higher than the proportion who underwent Ch-EVAR (69.6%, 16/23) (p\u0026thinsp;=\u0026thinsp;0.023). The postoperative incidence rate of type Ia endoleak was lower in S-EVAR (9.7% vs 13%, p\u0026thinsp;=\u0026thinsp;0.698). Times for. hospitalization, ICU monitoring, operation, and anesthesia, and perioperative bleeding were less in S-EVAR (12 vs 17 days, 0 vs 1 day, 122.5 vs 220 min, 177.5 vs 300 min, 50 vs 100 mL, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In S-EVAR, a suprarenal aortic angle was associated with type Ia endoleak (p\u0026thinsp;=\u0026thinsp;0.016). Median follow-up duration was 48 months, (range, 0\u0026ndash;94 months) in the S-EVAR group and 42 months (range, 0\u0026ndash;90 months) in the Ch-EVAR group. 1-year survival rate were (91.9% vs 91.3%), 3-year survival rate (81.7% vs 78.7%), 5-year survival rate (62.2% vs 45.8%) were not statistically different. No significant differences were found in postoperative complications. The long-term patency rate of chimney stent was 100%.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe off-label use of S-EVAR for JAAA, with a straight and 8\u0026ndash;10 mm aortic neck length, can be considered safe and effective. Ch-EVAR is more suitable for JAAA with excessive twisting of the neck (suprarenal aortic angle\u0026thinsp;\u0026lt;\u0026thinsp;114\u0026deg;). In this study, long-term data of both technologies showed satisfactory results in preventing aneurysm rupture and the related mortality.\u003c/p\u003e","manuscriptTitle":"Comparison of standard endovascular repair and chimney graft for juxtarenal abdominal aortic aneurysm","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-02 17:21:08","doi":"10.21203/rs.3.rs-3800230/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"086cd722-d1cc-4142-89d5-8b2a7010f131","owner":[],"postedDate":"January 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-21T06:08:00+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-02 17:21:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3800230","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3800230","identity":"rs-3800230","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}