Use of chimney grafts in aortic arch pathologies involving the supra-aortic branches.
Title | Use of chimney grafts in aortic arch pathologies involving the supra-aortic branches. |
Publication Type | Journal Article |
Year of Publication | 2011 |
Authors | Gehringhoff, B., Torsello G., Pitoulias G. A., Austermann M., & Donas K. P. |
Journal | J Endovasc Ther |
Volume | 18 |
Issue | 5 |
Pagination | 650-5 |
Date Published | 2011 Oct |
ISSN | 1545-1550 |
Keywords | Adult, Aged, Aorta, Thoracic, Aortic Diseases, Aortography, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation, Carotid Artery, Common, Endovascular Procedures, Female, Germany, Humans, Male, Middle Aged, Prosthesis Design, Stents, Subclavian Artery, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Ultrasonography, Doppler, Duplex |
Abstract | PURPOSE: To present a clinical experience with the use of chimney grafts in the endovascular repair of aortic arch pathologies involving the supra-aortic branches.METHODS: The chimney technique consists of endovascular stent or stent-graft placement parallel to the main aortic stent-graft in order to preserve or rescue flow to aortic branch vessels and to allow proximal extension of endograft fixation zones. Between April 2009 and January 2011, 9 patients (7 men; mean age 58 years, range 39-76) had chimney grafts installed to the left subclavian artery (LSA) or left common carotid artery (LCCA) during urgent thoracic endovascular aortic repair (TEVAR) of 5 aortic arch aneurysms, a mobile aortic thrombus with peripheral embolism, symptomatic type B dissection, penetrating aortic ulcer, and persistent type I endoleak after TEVAR. Eight chimney grafts were implanted into the LSA in 6 patients and 5 into the LCCA in the other 3 patients.RESULTS: The immediate technical success was 88.9%. The post-TEVAR type I endoleak persisted despite the chimney graft; the patient underwent surgical arch replacement. One patient died within 30 days due to cardiac insufficiency. There were 2 access site complications requiring surgery (brachial artery pseudoaneurysm and heavily calcified femoral artery puncture site). Over a median follow-up of 15 months (range 4-22), all chimney grafts remained patent in the 7 surviving and successfully treated patients.CONCLUSION: The use of chimney grafts in selected aortic arch pathologies with involvement of supra-aortic branches is safe and feasible. Long-term results and large series are needed in order to draw robust conclusions regarding this promising alternative endovascular technique. |
DOI | 10.1583/11-3504.1 |
Alternate Journal | J. Endovasc. Ther. |
PubMed ID | 21992634 |