A current systematic evaluation and meta-analysis of chimney graft technology in aortic arch diseases

Ahmad, Wael; Mylonas, Spyridon N.; Majd, Payman; Brunkwall, Jan

doi:10.1016/j.jvs.2017.06.100

Cited by 54 publications

(31 citation statements)

References 36 publications

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“…Despite encouraging initial results, further studies are required to standardize this technique [19,20,21]. Chimney technique to extend the proximal landing zone in TEVAR is feasible in the majority of vascular centers, with satisfied midterm outcomes, but not without a risk of major complications [22][23][24][25]. Zhao et al [26] compared the outcomes of the chimney and hybrid technique for the reconstruction of a single arch branch and found that type Ia endoleak rate was significantly higher in the chimney group.…”

Section: Discussionmentioning

confidence: 99%

A case report of a hybrid procedure (visceral and partial aortic arch debranching) in the treatment of a challenging aneurysm of the thoracoabdominal aorta in the endovascular era

et al. 2020

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Introduction This paper aimed to present a hybrid approach as a less invasive and acceptable treatment. Case outline Because of respiratory failure, the patient was deemed at high risk for open repair. Standard thoracic endovascular aortic repair (TEVAR) was unfeasible, so the patient underwent the hybrid procedure-partial aortic arch debranching at the first stage, followed by visceral debranching and endovascular exclusion of thoracic aortic aneurysm as a final procedure. The postoperative course was uneventful and the patient was discharged 10 days after TEVAR and visceral debranching. Conclusion Staged hybrid procedure with combined debranching of the aortic arch and visceral arteries is feasible and should be considered as an alternative treatment option in patients with high-risk for open repair.

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Section: Discussionmentioning

confidence: 99%

A case report of a hybrid procedure (visceral and partial aortic arch debranching) in the treatment of a challenging aneurysm of the thoracoabdominal aorta in the endovascular era

et al. 2020

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“…A meta-analysis of 11 publications involving 373 patients who underwent chimney endografts for their aortic arch disease (reported overall technical success rates of 91.3%, overall estimated proportion of early type 1a endoleak of 9.4% and retrograde type A dissection of 1.8%. The reported pooled 30-day mortality was 7.9%, with a reintervention rate of 10.6% and major strokes rate of 2.6% [30]. No long-term data exists regarding the durability of the chimney graft in the aortic arch.…”

Section: Chimney Grafts/parallel Graft/periscopementioning

confidence: 99%

“…Balloon expandable stents are preferable to self-expanding due to their accurate deployment and higher radial force [29]. Chimneys are mostly performed for acute emergency reasons such as dissection, IMH and pseudoaneurysm, with the commonly used proximal landing zone site is in zone 2, and frequently done for a single vessel [30]. This technique is relatively cheaper to use, and it is perceived as less technically demanding [7].…”

Section: Chimney Grafts/parallel Graft/periscopementioning

confidence: 99%

Various Endoluminal Approaches Available for Treating Pathologies of the Aortic Arch

Anwar

Hamady

2020

Cardiovasc Intervent Radiol

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Open surgical repair of the aortic arch for degenerative aortic disease in an unfit patient is associated with significant morbidity and mortality. Endoluminal techniques have advanced over the last decade. Contemporary endovascular options including a hybrid approach (supra-aortic debranching and aortic stent graft), inner branched endograft, chimney stents, and scallop or fenestrated endografts are being used frequently as an alternative to open surgical arch repair. Understanding of the available endoluminal technology along with careful planning and effective teamwork is required to minimise complications associated with the endoluminal techniques, particularly neurological ones. Custom made techniques are superior to chimney or parallel technology in terms of their complications and durability. Integration of the protective devices such as embolic protection filters into stent design may reduce the risk of poor neurological sequelae. Long-term data are needed to assess the durability of these devices.

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“…The principal advantage of this off label technique is in its use of off-theshelf components and techniques familiar to most operators to achieve a more proximal landing zone during arch TEVAR. The disadvantage of this technique is the creation of gutters around the aortic endoprosthesis with a 6.4-9.4% rate of type IA endoleak (24,25).…”

Section: Repair With Parallel Graftsmentioning

confidence: 99%

Cerebral embolic protection during endovascular arch replacement

Herman¹,

Rosu²,

Abraham³

2018

Ann. Cardiothorac. Surg.

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Despite excellent results in high volume centers, open repair of aortic arch pathology is highly invasive, and can result in significant morbidity and mortality in high risk patients. Near-total and hybrid approaches to aortic arch disease states have emerged as an alternative for patients deemed moderate to high risk for conventional repair. Advantages of these approaches include avoidance of extracorporeal circulation and hypothermic circulatory arrest as well as avoidance of cross clamping, all of which are not well tolerated in high risk patients. Anatomically high-risk patients with anastomotic aneurysms from previous arch reconstruction may also benefit from these less invasive approaches. Medical devices designed specifically for the aortic arch are developing at a rapid pace and continue to evolve. Dedicated devices for zone 0-2 aortic arch repair are currently available under special access or being studied in clinical trials. Unfortunately, stroke continues to be the Achilles heel of endovascular approaches to the aortic arch, with cerebral embolism being the culprit in the majority of such cases. This perspective article describes the epidemiology, procedures, and mitigation strategies for current near-total and hybrid approaches to aortic arch pathology, and specifically addresses current means of embolic protection and future direction.

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A current systematic evaluation and meta-analysis of chimney graft technology in aortic arch diseases

Cited by 54 publications

References 36 publications

A case report of a hybrid procedure (visceral and partial aortic arch debranching) in the treatment of a challenging aneurysm of the thoracoabdominal aorta in the endovascular era

A case report of a hybrid procedure (visceral and partial aortic arch debranching) in the treatment of a challenging aneurysm of the thoracoabdominal aorta in the endovascular era

Various Endoluminal Approaches Available for Treating Pathologies of the Aortic Arch

Cerebral embolic protection during endovascular arch replacement

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