Endovascular Chimney Technique for Aortic Arch Pathologies Treatment: A Systematic Review and Meta-Analysis

Li, Yue; Hu, Zhongzhou; Wang, Jianchang; Zhang, Yue; Chen, Zhong; Zhang, Hongchao

doi:10.1016/j.avsg.2017.09.006

Cited by 28 publications

(9 citation statements)

References 35 publications

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“…However, our results are comparable to a meta-analysis on chimney graft technique for aortic arch pathologies, with a pooled technical success rate of 91%. 37 The frequency of endoleaks was comparable to previously reported figures 38 ; however, we acknowledge that an endoleak which may be tolerable in an elective aneurysm setting may not be so in a BTTAI. Although the endoleak resolved spontaneously in one patient, it does not allow for a firm conclusion on whether this is the expected sequela in all untreated endoleaks.…”

Section: Discussionsupporting

confidence: 85%

Chimney parallel grafts and thoracic endovascular aortic repair for blunt traumatic thoracic aortic injuries: A systematic review

et al. 2018

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Background Whilst the management of blunt traumatic thoracic aortic injury has seen a paradigm shift to an ‘endovascular first’ approach, the limitations of thoracic endovascular aortic repair remain. An inadequate proximal landing zone limits the use of thoracic aortic stent grafts and in an emergent polytrauma setting, aortic arch debranching via open surgery may not be practical or feasible. A wholly endovascular approach to debranching utilising ‘off-the-shelf’ stents and parallel graft techniques may represent a possible solution. Hence, we sought to perform a systematic review investigating the use of chimney graft techniques alongside thoracic aortic stenting in blunt traumatic thoracic aortic injury. Methods We performed the systematic review in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Searches were performed on Medline (PubMed), Web of Science and Scopus to identify articles describing the use of chimney grafts in traumatic aortic transection (PROSPERO: CRD42017082549). Results The systematic search revealed 172 papers, of which 88 duplicates were removed resulting in 84 papers to screen. Based on title, abstract and full text review, six articles were included for final analysis. There were nine patients in total with an average age of 41 (three females, five males, one unspecified), all with significant polytrauma, secondary to the mechanism of injury. A variety of stents were used between centres, with techniques showing a predominance to stenting of the left subclavian artery (77%, n = 7). The technical success rate was 82%, with two (18%) cases of type 1 endoleaks, of which one resolved spontaneously. Conclusions Despite the encouraging results, this by no means provides for a firm conclusion given the small sample size. Patients should still be judiciously selected on a case-by-case basis when employing the chimney graft technique. Larger cohort studies are needed to establish these findings.

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Section: Discussionsupporting

confidence: 85%

Chimney parallel grafts and thoracic endovascular aortic repair for blunt traumatic thoracic aortic injuries: A systematic review

et al. 2018

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“…The official recommendations of the European Society for Vascular Surgery suggest TEVAR as the treatment of choice in these cases. 9,10 The endovascular approach for the aortic arch has progressed from options such as chimney technique, in situ fenestrations, and hybrid arch procedures [11][12][13] to more sophisticated endovascular solutions, such as branched or fenestrated arch repair. 14 Experience with these procedures has reached a level of maturity after overcoming the initial learning curve.…”

mentioning

confidence: 99%

Single-center experience with an inner branched arch endograft

Tsilimparis¹,

Detter²,

Law³

et al. 2019

Journal of Vascular Surgery

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“…Chimney was an option; however, the rate of type 1 endoleak for this repair in the aortic arch remains sustainable. 8 In situ fenestration of the supra-aortic trunks was a feasible option that requires the use of an extracorporeal circulation. 9 The alternative hybrid option requiring total debranching of supra-aortic trunks and bypass from the ascending aorta combined with a standard endograft was obviously more invasive and associated with a significant risk of de-containing the rupture during the ascending aorta exposure.…”

Section: Discussionmentioning

confidence: 99%

Double Fenestrated Physician-Modified Stent Graft for Endovascular Treatment of Traumatic Aortic Isthmus Rupture With an Aberrant Right Subclavian Artery

et al. 2022

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Purpose: The purpose of the study was to demonstrate the feasibility of urgent endovascular treatment of a traumatic aortic isthmus rupture in a patient with an aberrant right subclavian artery. Case report: A 23-year-old man was admitted to a regional trauma center after a motor vehicle collision and found to have cerebral trauma and a large pseudoaneurysm of the aortic arch. Trauma computed tomography (CT) identified a blunt traumatic thoracic aortic injury with an aortic false aneurysm in the context of an aberrant right subclavian artery. A hybrid repair was performed with bilateral subclavian carotid bypasses and a double fenestrated physician-modified stent graft. The patient had an uneventful postoperative course. Postoperative CT scan showed sealing of the aortic arch rupture and patency of all the supra-aortic trunks. Conclusion: Endovascular repair of blunt traumatic thoracic aortic injury is considered first-line therapy. Aortic arch anomalies add complexity to treatment. This report demonstrates that a hybrid strategy with bilateral carotid-axillary bypasses and homemade double fenestrated endograft of the aortic arch is a valuable approach for this challenging emergency in the context of an aberrant right subclavian artery.

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Endovascular Chimney Technique for Aortic Arch Pathologies Treatment: A Systematic Review and Meta-Analysis

Cited by 28 publications

References 35 publications

Chimney parallel grafts and thoracic endovascular aortic repair for blunt traumatic thoracic aortic injuries: A systematic review

Chimney parallel grafts and thoracic endovascular aortic repair for blunt traumatic thoracic aortic injuries: A systematic review

Single-center experience with an inner branched arch endograft

Double Fenestrated Physician-Modified Stent Graft for Endovascular Treatment of Traumatic Aortic Isthmus Rupture With an Aberrant Right Subclavian Artery

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