Efficacy and durability of the chimney graft technique in urgent and complex thoracic endovascular aortic repair

Abstract

The midterm to long-term results of the CG technique for urgent and complex lesions of the thoracic aorta in high-risk patients are promising, with low early mortality and long durability of the CGs. More patients with longer follow-up are still needed.

Chimney Grafts in Aortic Stent Grafting: Hazardous or Useful Technique? Systematic Review of Current Data

“…No strict guidelines exist. Surprisingly, the majority of CGs both visceral 6,7,21,23 and thoracic 27,32,37 were used in elective procedures. This may explain the low 30 day mortality and also implies that CGs were selected in many cases where more established endovascular techniques would have been applicable, including the use of complex custom made stent grafts.…”

Total aortic arch endovascular repair using an iliac branch device

“…The chimney graft technique in the aortic arch is reported to be associated with low mortality rates despite risk of stroke and endoleaks at follow-up due to an inadequate seal between chimney graft, aortic stent graft, and aortic wall (gutters). 4,5 In our case, because of the patient's comorbidities and urgent condition, the double chimney technique was preferred. To obtain a good seal between the chimney stent graft and the artery for the size of the anonymous trunk (usually >10 mm), the hypogastric component of the Excluder iliac branch endoprosthesis could be a good solution because of its 16-mm proximal diameter.…”

In vitro Stent Graft Fenestration to Preserve All Supra-aortic Branches in the Treatment of a Stanford Type A Aortic Arch Dissection

“…[1] Thoracic endovascular aortic repair (TEVAR) with associated techniques to reconstruct all supra-aortic branches is still controversial. [23] Herein, we reported a new endovascular method.…”

“…At present, there are some endovascular techniques designed for the treatment of ascending aorta and aortic arch pathologies. [234] However, creating patient-specific customized fenestrated, branched stent graft is time-consuming and expensive,[2] which limits its application, especially in emergency situations. The chimney technique is a developing off-the-shelf choice.…”

“…The chimney technique is a developing off-the-shelf choice. [3] However, reconstruction of all supra-aortic branches is hard to achieved and unreliable for all of them. [23] Besides, using fenestration to cover the whole region of aortic dissection and aortic arch may increase stability, compared to pure zone 0 treatment of dissection.…”