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

Abstract

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.

<p>Outcomes Of Chimney Technique For Aortic Arch Diseases: A Single-Center Experience With 226 Cases</p>

“…In our study, 37 (16%) immediate ELIa were reported. While there was not any substantial difference among immediate ELIa as well as non-immediate ELIa groups about the all-cause death, aorta-specific death or key AEs, consistent with previously published studies,13,29 efforts shall be taken to minimize ELIa. Several methods have been described in literature to reduce the occurrence of ELIa.…”

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

“…A main problem for aneurysm repair after the CG method is the gutter endoleak, a type Ia endoleak resulting from incomplete adherence of the main stent graft to the CG and aortic wall, which may lead to incomplete exclusion of an aneurysm. The disappearance of this gutter endoleak may occur, which was the case during follow-up for all of the endoleaks reported by Zhu et al, 25 for the two reported in the series of Huang et al, 22 for the three reported by Lu et al, 21 for two of the five endoleaks in the series of Xue et al, 27 and for the only reported endoleak by Shirakawa et al 18 On the other hand, two newly detected type Ia endoleaks were reported by Bin Jabr et al 20 during the follow-up period.…”

Outcomes of Chimney Technique for Preservation of the Left Subclavian Artery in Type B Aortic Dissection

“…Both covered and bare stents have been used, but a consensus has not been reached about which is more suitable. 14,15,26,28 For cases of supra-arch branch dissection, or a tear near the supra-arch branch ostium, the present authors prefer use of a covered stent because it might be more helpful in establishing a blind channel to decrease the risk of endoleak around the chimney stent. However, some of the covered stents had to be implanted by surgical access because of their large delivery system; whereas, with a thin delivery system, the bare stent can be implanted by percutaneous radial artery access.…”

“…For patients with TBAD, Huang et al suggest that the gutter should be formed as far away from the entry tear as possible. 26 The kissing balloon technique should be used with extreme caution as excessive angioplasties may cause retrograde type A aortic dissection, especially in cases of acute TBAD with a highly fragile aortic wall. Another promising technique to handle the ELIa is to selectively catheterise and embolise the gutter with coils.…”

“…2); findings which are similar to previous studies. 15,26 The ideal configuration for chimney grafts remains a controversial topic. Both covered and bare stents have been used, but a consensus has not been reached about which is more suitable.…”