Periscope Endograft Technique to Revascularize the Left Subclavian Artery During Thoracic Endovascular Aortic Repair

Lachat, Mario; Mayer, Dieter; Pfammatter, Thomas; Criado, Frank J.; Rančić, Zoran; Larzon, Thomas; Veith, Frank J.; Pecoraro, Felice

doi:10.1583/13-4884r.1

Cited by 32 publications

(26 citation statements)

References 24 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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“…Thus, the high-speed aortic flow could lead to a type I endoleak. In contrast, in the periscope technique, [7][8][9][10][11][12][13] the reconstruction of the supra-arch branches is located in the aortic stent-graft, with the periscope grafts perfused in a retrograde manner, thus avoiding the rush of blood toward the gutters. Therefore, blood in either the stent-grafts or the gutters is driven only by the pressure difference, and the blood in the gutters could easily form clots when the blood remains static at a balanced pressure between the true and false lumens.…”

Section: Discussionmentioning

confidence: 99%

Sandwich Technique for Endovascular Repair of Acute Type A Aortic Dissection

et al. 2017

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Overview: To describe a new endovascular procedure for acute type A aortic dissection (TAAD) repair. Methods: Between 2013 and 2016, 12 patients (average age 54±9.6 years; 10 men) with acute TAAD (mean EURO score 11.4%±3.2%, range 5-17) and unfit for surgery underwent thoracic endovascular aortic repair (TEVAR) with 2 periscope grafts to preserve blood supply to supra-aortic branches plus bypass grafting as needed. If the ascending aorta was dilated to >40 mm, sternotomy was performed to wrap the ascending aorta and reduce its diameter to accommodate the aortic stentgrafts. Results: All patients were successfully treated. Seven patients required bypass grafting, and most of the patients had periscope grafts to the innominate/right common carotid artery and left common carotid artery; only 3 patients had the left subclavian artery preserved. All patients exhibited good hemodynamics and normal pressures after the procedure. The mean procedure time and blood loss were 4.5±1.0 hours and 217±111.5 mL, respectively. Two patients treated emergently died shortly after surgery from multiorgan failure. The average follow-up duration was 17±14.5 months (range 2-42) in the 10 survivors. The remaining patients recovered and none experienced stent-graft thrombosis, stroke, or peripheral artery embolism during follow-up. Conclusion: A procedure that combines sandwich/periscope grafting with TEVAR, wrapping of the aorta, and supra-arch bypass grafting can be used to treat patients with acute TAAD.

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“…In addition, the Viabahn X-ray visibility may increase with primary Wallstent relining. 10 This tool was employed increasingly in the later procedures, especially in cases of multiple CPGs. Finally, the 4 year cumulative patency rate of aortic branches preserved with CPGs is equivalent to those reported after B/FEVAR treatment for similar aortic pathologies (96% vs. 88.6%).…”

Section: Discussionmentioning

confidence: 99%

“…In the latter part of the experience (7 cases; 7%) the CPGs were relined primarily with Wallstents (Boston Scientific Corp., Marlborough, MA, USA) to improve visibility. 10 In 22 (22%) cases a visceral debranching of one or two branches preceded the CPGs.…”

Section: Implantation Techniquementioning

confidence: 99%

Mid- and Longer-term Follow up of Chimney and/or Periscope Grafts and Risk Factors for Failure

Pecoraro¹,

Veith²,

Puippe³

et al. 2016

Journal of Vascular Surgery

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WHAT THIS PAPER ADDS Long-term follow up of chimney and periscope grafts for the treatment of pararenal and thoraco-abdominal aortic aneurysm is presented. This approach using off the shelf devices has been increasingly reported in recent years and with good results even in emergent settings. This risk factor analysis showed that inadequate branch graft length and chimney and periscope use in small and diseased target arteries contribute to late failure of this technique.Objective: The aim was to report on chimney and periscope grafts (CPGs) and their mid-and longer-term outcomes when they are used to preserve reno-visceral artery (RVA) perfusion in endovascular repair of pararenal (PRAAs) or thoraco-abdominal aortic aneurysm (TAAAs). In addition, factors associated with CPG failure are presented. Limited data exist on the outcomes of CPGs, and mid-and long-term results are generally not reported.Methods: This was a prospective study in a cohort of 100 patients with PRAA (69) or TAAA (31). A total of 224 (mean 2.24 per patient) RVAs were preserved with 136 (61%) chimney and 88 (39%) periscope grafts. CPGs were constructed mainly using self expandable stent grafts. Patients were followed by clinical examination, CTA (82%), and/or duplex (18%). Data were collected until February 2015. Results: CPG immediate technical success was 99% (222/224 branches). Mean follow up was 29 months (range 0e65; SD 17); 59% patients were followed > 2 years, 30% > 3 years, and 16% > 4 years. Post-operatively, CPG occlusion was observed early ( 30 days) in three (1.3%) branches and during follow up in 10 (4.5%). At 36 and 48 months, the estimated primary patency was 93% and 93%. After corrective percutaneous (10) or surgical (3) reinterventions, the estimated secondary patency was 96% and 96%. Thirty day mortality was 2%; at 36 and 48 months the estimated patient survival was 79%. Significant shrinkage (72 [SD 23] vs. 62 [SD 24] mm; p < .001) was observed, with a substantial reduction (>5 mm) in 55 patients, and sac enlargement in four. Incomplete aneurysm sac sealing was treated successfully by a secondary intervention in 15 patients. Conclusions: Self expandable CPGs have proved to be a highly successful and durable treatment for RVA preservation up to 5 years. Incomplete CPG expansion, inadequate length, and CPG use in small and diseased target arteries were risk factors for occlusion. These mid-and longer-term results support CPG use to treat PRAAs or TAAAs in patients unfit for open surgery or fenestrated/branched stent grafts. Ó

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Periscope Endograft Technique to Revascularize the Left Subclavian Artery During Thoracic Endovascular Aortic Repair

Cited by 32 publications

References 24 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

Sandwich Technique for Endovascular Repair of Acute Type A Aortic Dissection

Mid- and Longer-term Follow up of Chimney and/or Periscope Grafts and Risk Factors for Failure

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