Thoracic endovascular aortic repair with the chimney graft technique

Hogendoorn, Wouter; Schlösser, Felix J.V.; Moll, Frans L.; Sumpio, Bauer E.; Muhs, Bart E.

doi:10.1016/j.jvs.2013.03.043

Cited by 124 publications

(118 citation statements)

References 37 publications

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“…Only one of the seven patients with a stented brachiocephalic trunk remains alive. This finding concurs with other reports (Hogendoorn et al 2013).…”

Section: Figure 21supporting

confidence: 94%

Impact of Renal Chimney Grafts on Anatomical Suitability for Endovascular Repair in Ruptured Abdominal Aortic Aneurysm

et al. 2015

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Introduction: Open repair of the aorta carries a high risk for morbidity and mortality especially in the elderly population and in patients unfit for major surgery. Endovascular aortic repair is safe, durable and effective when there is adequate proximal and distal sealing zone for the aortic stent graft. Fenestrated and branched stent grafts have made the repair possible for complex but elective cases that do not have an adequate sealing zone. Urgent complex cases and patients with midaortic occlusive diseases do not have any therapeutic alternative if they are not fit for open repair. Chimney graft technique fills this gap and allows the sealing zones for aortic stent graft to be extended as required. The aim of the present thesis is to study the applicability, safety and durability of CG technique in urgent cases with complex lesions in the thoracic and abdominal aorta including the midaortic occlusive diseases. Patients and Methods: All patients who received CG were treated urgently or semi-urgently. The majority of the treated aortic lesions were aneurysms, dissections, pseudoaneurysms, infection, and accidental overstented vital aortic side branches. The median age of all patients was 75 years (IQR, 69-78), of them 32% were female except for the first study where all ten patients were female with midaortic occlusive diseases. The second study evaluated the mid to long-term efficacy and durability of the CG technique in 29 patients with urgent and complex lesions of the thoracic aorta. The third study examined the long-term results of CG in preserving the visceral flow of 51 patients with urgent complex aortic lesions. The fourth study evaluated the CTA images of 206 patients with ruptured abdominal aortic aneurysm. The study measured the applicability of CG in patients for whom standard EVAR was contraindicated because of a short aneurysmal neck. Results:The results showed that CG is applicable and safe for midaortic occlusive diseases with high technical success and patency rate without major adverse effect. The treated patients with thoracic aortic lesions had 14% 30-day mortality, 21% type I endoleak, 7% CG-related mortality, 98% secondary patency and 68% of the aortic lesions shrank significantly. Visceral CG had a 10% 30-day mortality, 6% CG-related mortality, 12% type I endoleak, 93% secondary patency and 63% of the aortic lesions shrank significantly. Twenty-two patients had one renal arteriy sacrificed, 57% of these required permanent renal dialysis. The fourth study proved that CG technique increased the overall suitability for endovascular repair from 34% to 40-46%. Conclusions: Chimney graft seems effective and safe for treating midaortic occlusive diseases in patients unfit for open surgery. The early and mid to long-term results of the CG technique for urgent and complex lesions of the thoracic and abdominal aorta in high-risk patients are promising with a low early mortality, acceptable rate of type I endoleaks and long durability of the CGs, which may justify a broader applicability of this ...

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“…Only one of the seven patients with a stented brachiocephalic trunk remains alive. This finding concurs with other reports (Hogendoorn et al 2013).…”

Section: Figure 21supporting

confidence: 94%

Impact of Renal Chimney Grafts on Anatomical Suitability for Endovascular Repair in Ruptured Abdominal Aortic Aneurysm

et al. 2015

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“…Compared with extra-anatomical bypass and branched endografting, the incidence of neurological sequelae with the chimney technique is lower due to less manipulation of target vessels and the aortic arch. 6,9,10,28 In the current study, 32 (28.1%) of 114 LCCA chimneys were deployed via a percutaneous approach, and all the chimneys in the IA were inserted via a right brachial access. The only stroke was caused by migration and compression of the chimney grafts.…”

Section: Discussionmentioning

confidence: 94%

“…[12][13][14] Access sites were closed, and aspirin (100 mg/d) was prescribed to patients after TEVAR. 9,[12][13][14] All patients had a CTA and duplex ultrasound scan 2 weeks after TEVAR to evaluate the coverage of aortic lesions and the supra-aortic branch patency. Subsequent follow-up with physical examination and CTA was scheduled at 3, 6, and 12 months and annually thereafter.…”

Section: Chimney Tevar Proceduresmentioning

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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“…2,3) Neurointerventionist may be requested to treat such a condition although the procedure is intrinsically a specialty of vascular surgeons, so they must have knowledge about the procedure as an emergency measure to prevent ischemic complications of balloon expandable stent has excellent operability and vascular compatibility and is already in wide use for stenotic lesions of the subclavian artery although it was originally developed for the iliac artery. We obtained satisfactory outcomes in our two patients by applying this device to the orifice of the left common carotid artery.…”

Section: Discussionmentioning

confidence: 99%

Emergency Retrograde Left Common Carotid Artery Stenting after Thoracic Endovascular Aortic Repair with Regional Cerebral Oxygen Saturation Monitoring: Report of Two Cases

Kikuchi

Ando

Nakazawa

et al. 2018

JNET

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Objective: Two cases in which emergency retrograde stenting were performed for occlusion of the left common carotid artery orifice that occurred during thoracic endovascular aortic repair are reported. Case Presentations:In males in their 70s with thoracic aortic aneurysm, oxygen saturation dropped in the left cerebrum immediately after deployment of the thoracic aortic stent graft under general anesthesia. The stent graft obstructed the orifice of the left common carotid artery, and recanalization was achieved by direct puncture of the cervical left common carotid artery and placing a balloon expandable stent at the orifice of the left common carotid artery. No postprocedural neurologic deficits were observed. Conclusion:Retrograde stenting of the orifice of the left common carotid artery is effective for thoracic aortic stent graft migration, and regional cerebral oxygen saturation is an important index. The cases are worth reporting as neurointerventionist may also be required to perform the procedure, which is usually performed by vascular surgeons.

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Thoracic endovascular aortic repair with the chimney graft technique

Cited by 124 publications

References 37 publications

Impact of Renal Chimney Grafts on Anatomical Suitability for Endovascular Repair in Ruptured Abdominal Aortic Aneurysm

Impact of Renal Chimney Grafts on Anatomical Suitability for Endovascular Repair in Ruptured Abdominal Aortic Aneurysm

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

Emergency Retrograde Left Common Carotid Artery Stenting after Thoracic Endovascular Aortic Repair with Regional Cerebral Oxygen Saturation Monitoring: Report of Two Cases

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