Double-Barrel Technique for Endovascular Exclusion of an Aortic Arch Aneurysm Without Sternotomy

Baldwin, Zachary K.; Chuter, Timothy A.M.; Hiramoto, Jade S.; Reilly, Linda M.; Schneider, Darren B.

doi:10.1583/07-2308.1

Cited by 59 publications

(32 citation statements)

References 14 publications

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“…The use of a covered stent in the chimney technique was first reported by Hiramoto et al 16 in 2006 to decrease the incidence of endoleak. These techniques are also described as double-barrel, 17 periscope, 18 snorkel, 19 or sandwich. 20 The risk of type Ia endoleak is the main problem with the chimney technique because of the "gutter" between the chimney and aortic stent-grafts.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies

Wang

Shu

et al. 2017

J Endovasc Ther

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Purpose: To summarize a single-center experience using the single/double chimney technique in association with thoracic endovascular aortic repairs (TEVAR) for aortic arch pathologies. Methods: From November 2007 to March 2016, 122 patients (mean age 50.4±12.7 years, range 29-80; 92 men) with aortic arch pathologies underwent TEVAR combined with single (n=101) or double (n=21) chimney grafts to reconstruct the supra-aortic branches: 21 innominate arteries, 114 left common carotid arteries, and 8 left subclavian arteries (LSA). Pathologies included type B aortic dissection (n=47), aortic arch dissection (n=49), retrograde type A aortic dissection (n=8), thoracic aortic aneurysm (n=7), penetrating aortic arch ulcer (n=9), and post-TEVAR type I endoleak (n=2). Follow-up examinations included computed tomography at 0.5, 3, 6, and 12 months and yearly thereafter. Results: The aortic stent-grafts were deployed in zone 0 (n=21), zone 1 (n=93), and zone 2 (n=8). One (0.8%) of the 122 patients died at 4 days due to a perforated peptic ulcer. Type Ia endoleaks were found intraoperatively in 13 (10.7%) patients, including 3 with the double chimney technique. Type II endoleaks occurred in 6 (4.9%) patients; 3 were treated with duct occluders in the LSA. Postoperative chimney graft migration occurred in 1 (0.8%) patient with double chimneys; additional stent-grafts were deployed in both chimneys. Median follow-up was 32.3 months, during which 1 (0.8%) patient died after a stroke at 3 months. Chimney stent-graft patency was observed in the remaining 120 patients. Two (1.7%) secondary TEVARs were performed for distal aortic dissection. Nine asymptomatic type Ia endoleaks and 1 type II endoleak persisted in follow-up; a type II endoleak in 1 patient with Marfan syndrome sealed in 52 months. Conclusion: TEVAR with the chimney technique provides a safe, minimally invasive alternative with good chimney graft patency and low postoperative mortality during midterm follow-up. The double chimney technique should be used judiciously owing to its potential complications.

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Section: Discussionmentioning

confidence: 99%

Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies

Wang

Shu

et al. 2017

J Endovasc Ther

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“…Covered stent might be helpful for reducing the risk of endoleak since it can decrease the blood flow coming via the meshes of bare stent into the gutter. Moreover, the gutter is like a blind channel, where thrombosis could be formed and be a cause of cerebral emboli, and covered stents might reduce this risk [19]. However, the large delivery system is the main drawback of the covered stent.…”

Section: Discussionmentioning

confidence: 99%

Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

Huang

Tang

Qiao

et al. 2015

Cardiovasc Intervent Radiol

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Objective To summarize our early experience gained from the chimney technique for type B aortic dissection (TBAD) extending to the aortic arch and to evaluate the aortic remodeling in the follow-up period. Methods From September 2011 to July 2014, 27 consecutive TBAD patients without adequate proximal landing zones were retrograde analyzed. Chimney stent-grafts were deployed parallel to the main endografts to reserve flow to branch vessels while extending the landing zones. In the follow-up period, aortic remodeling was observed with computed tomography angiography. Results The technical success rate was 100 %, and endografts were deployed in zone 0 (n = 3, 11.1 %), zone 1 (n = 18, 66.7 %), and zone 2 (n = 6, 22.2 %). Immediately, proximal endoleaks were detected in 5 patients (18.5 %). During a mean follow-up period of 17.6 months, computed tomography angiography showed all the aortic stent-grafts and chimney grafts to be patent. Favorable remodeling was observed at the level of maximum descending aorta and left subclavian artery with expansion of true lumen (from 18.4 ± 4.8 to 25 ± 0.86 mm, p \ 0.001 and 27.1 ± 0.62 to 28.5 ± 0.37 mm, p \ 0.001) and depressurization of false lumen (from 23.7 ± 2.7 to 8.7 ± 3.8 mm, p \ 0.001, from 5.3 ± 1.2 to 2.1 ± 2.1 mm, p \ 0.001). While at the level of maximum abdominal aorta, suboptimal remodeling of the total aorta (from 24.1 ± 0.4 to 23.6 ± 1.5 mm, p = 0.06) and true lumen (from 13.8 ± 0.6 to 14.5 ± 0.4 mm, p = 0.08) was observed. Conclusion Based on our limited experience, the chimney technique with thoracic endovascular repair is demonstrated to be promising for TBAD extending to the arch with favorable aortic remodeling.

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“…Procedures of this type are performed only in a few centers around the world. The design and making of such graft takes a few weeks which limits utility of this method to stable patients (18,19).…”

Section: Discussionmentioning

confidence: 99%

Hybrid Operation of Posttraumatic Dissecting Aneurysm of Descending Aorta - Case Report

Szopiński¹,

Stryga²,

Terlecki³

2010

Polish Journal of Surgery

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. The patient underwent successful hybrid treatment for a dissecting aneurysm of the descending aorta. The dissection was repaired using a bimodular stent-graft Zenith TX-2 Zenith, Cook, covering origins of the left subclavian artery and left common carotid artery. Blood flow in the neck was restored using non-anatomical anastomoses: the left common carotid artery was connected with the right common carotid artery and left subclavian artery.

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Double-Barrel Technique for Endovascular Exclusion of an Aortic Arch Aneurysm Without Sternotomy

Abstract: The "double-barrel" stent technique may extend the limits of thoracic endografting by preserving the aortic arch branches while avoiding the need for sternotomy. Using this technique, proximal fixation can be obtained well into the ascending aorta using commercially available devices.

Cited by 59 publications

References 14 publications

Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies

Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies

Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

Hybrid Operation of Posttraumatic Dissecting Aneurysm of Descending Aorta - Case Report

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