Double-chimney technology for treating secondary type I endoleak after endovascular repair for complicated thoracic aortic dissection

Feng, Rui; Zhao, Zhi‐Qing; Bao, Junmin; Wei, Xiaolong; Wang, Liang; Jing, Zaiping

doi:10.1016/j.jvs.2010.11.120

Cited by 30 publications

(27 citation statements)

References 15 publications

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“…In total, 12 articles met the inclusion criteria and were thoroughly examined. 20,23e26,29e35 Out of those only two articles described the double-chimney technique 30,35 and the rest e a single chimney-graft of IA, LCCA or LSA respectively (Table 4).…”

Section: Literature Reviewmentioning

confidence: 99%

Triple-barrel Graft as a Novel Strategy to Preserve Supra-aortic Branches in Arch-TEVAR Procedures: Clinical Study and Systematic Review

Shahverdyan

Gawenda

Brunkwall

2013

European Journal of Vascular and Endovascular Surgery

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Section: Literature Reviewmentioning

confidence: 99%

Triple-barrel Graft as a Novel Strategy to Preserve Supra-aortic Branches in Arch-TEVAR Procedures: Clinical Study and Systematic Review

Shahverdyan

Gawenda

Brunkwall

2013

European Journal of Vascular and Endovascular Surgery

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“…Since the initial description, there has been rapid proliferation and application of “chimney” techniques in the management of paravisceral aortic disease 9, 11–13 . Not surprisingly, this technique is now being increasingly applied to more proximal aortic/arch disease treated during TEVAR 14–17 . The allure of this approach is that it provides a near total endovascular solution and can be completed with readily available technologies using implantation techniques familiar to most operators performing TEVAR.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of thoracic endovascular aortic repair using aortic arch chimney stents in high-risk patients

Voskresensky

Scali

Feezor

et al. 2017

Journal of Vascular Surgery

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Introduction Aortic arch disease is a challenging clinical problem, especially in high-risk patients where open repair can have morbidity and mortality rates of 30–40% and 2–20%, respectively. Aortic arch “chimney”(AAC) stents used during thoracic endovascular aortic repair(TEVAR) are a less invasive treatment strategy than open repair, but the current literature is inconclusive about the role of this technology. The focus of this analysis is to describe our experience with TEVAR and AAC stent(s). Methods All TEVAR procedures performed from 2002–15 were reviewed to identify those with AAC stents. Primary end-points were technical success, as well as 30-day and 1-year mortality. Secondary end-points included complications, reintervention, and endoleak. Technical success was defined as a patient surviving the index operation with deployment of the AAC stent(s) at the intended treatment zone with no evidence of type 1 or 3 endoleak on initial postoperative imaging. The Kaplan-Meier method was used to estimate survival. Results Twenty-seven patients(age:69±12 years[male 70%]) were identified, and all were described as prohibitive risk for open repair by the treating team. Relevant comorbidity rates were: coronary artery disease/myocardial infarction(59%), O2-dependent emphysema(30%), preoperative creatinine>1.8mg/dL(19%), and congestive heart failure(15%). Presentations included: elective-67%(n=18), symptomatic-26%(n=7), and ruptured-7%(n= 2). Eleven(41%) had prior endovascular and/or open arch/descending thoracic repair. Indications were: degenerative aneurysm(49%), chronic residual type A dissection with aneurysm(15%), type 1a endoleak after TEVAR(11%), post-surgical pseudoaneurysm(11%), penetrating ulcer(7%), and acute type B dissection(7%). 32 BC vessels were treated: innominate, n=7; left common carotid artery(LCCA), n=24; left subclavian artery(LSA), n=1. Five patients(19%) had simultaneous innominate-LCCA chimneys. BCC stents were planned in 75%(n=24) with the remainder placed for either LCCA or innominate artery encroachment(n=8). Overall technical success was 89%(1-intraoperative death, 2-persistent type 1a endoleaks in follow-up). 30-day mortality was 4%(n=1; intraoperative in a patient with a ruptured arch aneurysm) and median LOS was 6[IQR 4, 9] days. Seven(26%) patients experienced a major complication(stroke-3[all with unplanned BCC], respiratory failure-3, and death-1). Nine(33%) patients underwent aorta-related reintervention, and no chimney occlusion events occurred during follow-up(median follow-up:9[IQR 1,23] months). One and 3-year survival is estimated to be 88±6% and 69±9%, respectively. Conclusions TEVAR with AAC can be performed with high technical success and acceptable morbidity and mortality in high-risk patients. Unplanned AAC placement during TEVAR results in an elevated stroke risk, which may be related to the branch vessel coverage necessitating AAC placement. Acceptable mid-term survival can be anticipated, but aorta-related reintervention is not uncommon, and diligent follow-u...

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“…For the chimney device type, a covered stent graft would seem to provide a better seal than a bare stent. However, Feng, et al16 state that covered stent grafts offer no additional benefits, except that a long channel is required for the branch. Few data are available concerning the superiority and matching of different chimney devices.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Endovascular Aortic Repair with the Chimney Technique for Blunt Traumatic Pseudoaneurysm of the Aortic Arch in a No-Option Patient

et al. 2013

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A 42-year-old man was involved in a motor vehicle collision. Imaging studies revealed the presence of a post-traumatic aortic pseudo-aneurysm (about 34×26 cm) arising from the descending thoracic aorta at the level of the left subclavian artery (LSA), prone to rupture. Thoracic endovascular aneurysm repair (TEVAR) was the only feasible option due to his poor overall medical status. In this case, LSA needed to be covered in order to extend the proximal landing zone. Eventually, modified TEVAR was successfully performed by means of the chimney technique to preserve flow to the LSA and to prevent flow into the pseudoaneurysmal sac.

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Double-chimney technology for treating secondary type I endoleak after endovascular repair for complicated thoracic aortic dissection

Cited by 30 publications

References 15 publications

Triple-barrel Graft as a Novel Strategy to Preserve Supra-aortic Branches in Arch-TEVAR Procedures: Clinical Study and Systematic Review

Triple-barrel Graft as a Novel Strategy to Preserve Supra-aortic Branches in Arch-TEVAR Procedures: Clinical Study and Systematic Review

Outcomes of thoracic endovascular aortic repair using aortic arch chimney stents in high-risk patients

Thoracic Endovascular Aortic Repair with the Chimney Technique for Blunt Traumatic Pseudoaneurysm of the Aortic Arch in a No-Option Patient

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