Abstract
Purpose
To examine the safety, feasibility, and mid-term efficacy of the chimney technique for aortic arch pathologies.
Methods
From February 2011 to December 2014, a total of 35 patients (30 men; mean age 54.3 ± 14.1 years) with aortic arch pathologies underwent thoracic endovascular aortic repair combined with chimney stents. The indication was a proximal landing zone <1.5 cm. Follow-up was performed at 3, 6, and 12 months and then yearly thereafter.
Results
A total of 36 chimney stents were deployed (innominate artery, n = 1; left common carotid artery, n = 9; right subclavian artery, n = 1; left subclavian artery, n = 25). The technical success rate was 94.3 % (33/35). Immediate type Ia endoleaks (ELIa) were observed in two patients (8.6 %, 2/35). Twenty-five patients were successfully followed-up for a median period of 29.3 months (range, 6–48 months). One patient died due to aortic dissection aneurysm rupture at 36 months (mortality rate of 4 %, 1/25). Three late ELIa were observed and no reinterventions were performed. The overall incidence of ELIa was 20 % (5/25). During follow-up, the patency rate for chimney stents was 92 % (23/25).
Conclusion
Our limited experience demonstrates that the chimney technique is a viable and relatively safe treatment for patients with challenging thoracic aortic pathologies at least in the mid-term follow-up period.
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References
Bavaria JE, Appoo JJ, Makaroun MS, Verter J, Yu ZF, Mitchell RS, TAG Gore Investigators. Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: a multicenter comparative trial. J Thorac Cardiovasc Surg. 2007;133(2):369–77.
Yuan L, Feng X, Jing Z. Endovascular repair of a thoracic arch aneurysm with a fenestrated stent-graft. J Endovasc Ther. 2008;15(5):539–43. doi:10.1583/07-2111.1.
Kawaguchi S, Yokoi Y, Shimazaki T, Koide K, Matsumoto M, Shigematsu H. Thoracic endovascular aneurysm repair in Japan: Experience with fenestrated stent grafts in the treatment of distal arch aneurysms. J Vasc Surg. 2008;48(6 Suppl):24S–9S. doi:10.1016/j.jvs.2008.08.037 discussion 29S.
Yoshida RA, Kolvenbach R, Yoshida WB, Wassijew S, Schwierz E, Lin F. Total endovascular debranching of the aortic arch. Eur J Vasc Endovasc Surg. 2011;42(5):627–30. doi:10.1016/j.ejvs.2011.06.054.
Greenberg RK, Clair D, Srivastava S, Bhandari G, Turc A, Hampton J, Popa M, Green R, Ouriel K. Should patients with challenging anatomy be offered endovascular aneurysm repair? J Vasc Surg. 2003;38(5):990–6.
Mitchell RS, Ishimaru S, Ehrlich MP, Iwase T, Shimono T, Fattori R, Yutani C. First International Summit on Thoracic Aortic Endografting: roundtable on thoracic aortic dissection as an indication for endografting. J Endovasc Ther. 2002;9(Suppl 2):II98–105.
Yang J, Xiong J, Liu X, Jia X, Zhu Y, Guo W. Endovascular chimney technique of aortic arch pathologies: a systematic review. Ann Vasc Surg. 2012;26(7):1014–21. doi:10.1016/j.avsg.2012.05.014.
Antoniou GA, Mireskandari M, Bicknell CD, Cheshire NJ, Gibbs RG, Hamady M, Wolfe JH, Jenkins MP. Hybrid repair of the aortic arch in patients with extensive aortic disease. Eur J Vasc Endovasc Surg. 2010;40(6):715–21. doi:10.1016/j.ejvs.2010.08.024.
Gehringhoff B, Torsello G, Pitoulias GA, Austermann M, Donas KP. Use of chimney grafts in aortic arch pathologies involving the supra-aortic branches. J Endovasc Ther. 2011;18(5):650–5. doi:10.1583/11-3504.1.
Shu C, Luo MY, Li QM, Li M, Wang T, He H. Early results of left carotid chimney technique in endovascular repair of acute non-a-non-B aortic dissections. J Endovasc Ther. 2011;18(4):477–84. doi:10.1583/11-3401.1.
Liu H, Shu C, Li X, Wang T, Li M, Li QM, Fang K, Wang S. Endovascular aortic repair combined with chimney technique in the treatment of stanford type B aortic dissection involving aortic arch. Ann Vasc Surg. 2015;29(4):758–63. doi:10.1016/j.avsg.2014.12.004.
Zhu Y, Guo W, Liu X, Jia X, Xiong J, Wang L. The single-centre experience of the supra-arch chimney technique in endovascular repair of type B aortic dissections. Eur J Vasc Endovasc Surg. 2013;45(6):633–8. doi:10.1016/j.ejvs.2013.02.016.
Xue Y, Sun L, Zheng J, Huang X, Guo X, Li T, Huang L. The chimney technique for preserving the left subclavian artery in thoracic endovascular aortic repair. Eur J Cardiothorac Surg. 2015;47(4):623–9. doi:10.1093/ejcts/ezu266.
Huang C, Tang H, Qiao T, Liu C, Zhou M. Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch. Cardiovasc Intervent Radiol. 2015;39(1):1145–9.
Hogendoorn W, Schloesser FJ, Moll FL, Sumpio BE, Muhs BE. Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg. 2013;58(2):502–11. doi:10.1016/j.jvs.2013.03.043.
Shahverdyan R, Gawenda M, Brunkwall J. Triple-barrel graft as a novel strategy to preserve supra-aortic branches in arch-TEVAR procedures: clinical study and systematic review. Eur J Vasc Endovasc Surg. 2013;45(1):28–35. doi:10.1016/j.ejvs.2012.09.023.
Ullery BW, McGarvey M, Cheung AT, Fairman RM, Jackson BM, Woo EY, Desai ND, Wang GJ. Vascular distribution of stroke and its relationship to perioperative mortality and neurologic outcome after thoracic endovascular aortic repair. J Vasc Surg. 2012;56(6):1510–7. doi:10.1016/j.jvs.2012.05.086.
Buth J, Harris PL, Hobo R, van Eps R, Cuypers P, Duijm L, Tielbeek X. Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. a study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) registry. J Vasc Surg. 2007;46(6):1103–10.
Weigang EE, Luehr MM, Harloff AA, Euringer WW, Etz CD, Szabó GG, et al. Incidence of neurological complications following overstenting of the left subclavian artery. Eur J Cardiothorac Surg. 2007;31:628–36.
Zamor KC, Eskandari MK, Rodriguez HE, Ho KJ, Morasch MD, Hoel AW. Outcomes of thoracic endovascular aortic repair and subclavian revascularization techniques. J Am Coll Surg. 2015;221(1):93–100.
Patterson BO, Holt PJ, Nienaber C, Fairman RM, Heijmen RH, Thompson MM. Management of the left subclavian artery and neurologic complications after thoracic endovascular aortic repair. J Vasc Surg. 2014;60(6):1491–7.
Matsumura JS, Lee WA, Mitchell RS, Farber MA, Murad MH, Lumsden AB, Greenberg RK, Safi HJ, Fairman RM. Society for vascular surgery. the society for vascular surgery practice guidelines: management of the left subclavian artery with thoracic endovascular aortic repair. J Vasc Surg. 2009;50(5):1155–8.
Bin Jabr A, Lindblad B, Kristmundsson T, Dias N, Resch T, Malina M. Outcome of visceral chimney grafts after urgent endovascular repair of complex aortic lesions. J Vasc Surg. 2015;63(3):625–33.
Sugiura K, Sonesson B, Akesson M, Bjrses K, Holst J, Malina M. The applicability of chimney grafts in the aortic arch. J Cardiovasc Surg (Torino). 2009;50(4):475–81.
Criado FJ. Chimney grafts and bare stents: aortic branch preservation revisited. J Endovasc Ther. 2007;14(6):823–4.
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Junjie Zou, Yuanyong Jiao, Xiwei Zhang, Jun Jiang, Hongyu Yang, and Hao Ma declare that they have no conflict of interests and no grant supports for this work.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
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Zou, J., Jiao, Y., Zhang, X. et al. Early- and Mid-term Results of the Chimney Technique in the Repair of Aortic Arch Pathologies. Cardiovasc Intervent Radiol 39, 1550–1556 (2016). https://doi.org/10.1007/s00270-016-1439-6
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DOI: https://doi.org/10.1007/s00270-016-1439-6