European Multicenter Registry for the Performance of the Chimney/Snorkel Technique in the Treatment of Aortic Arch Pathologic Conditions

Bosiers, Michel; Donas, Konstantinos P.; Mangialardi, Nicola; Torsello, Giovanni; Riambau, Vincent; Criado, Frank J.; Veith, Frank J.; Ronchey, Silvia; Fazzini, Stefano; Lachat, Mario

doi:10.1016/j.athoracsur.2015.10.112

Cited by 88 publications

(92 citation statements)

References 25 publications

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“…He was converted to open surgery and underwent total arch replacement combined with a frozen elephant trunk implantation. 28 The present meta-analysis yielded a pooled retrograde dissection rate that is similar to that after TEVAR (2.2%) reported by Higashigawa et al 35 It seems as if aneurysmal disease has a lower incidence of <1% compared with dissection of around 5%. If it is necessary to go deeper into the arch, one may speculate that the chimneys in the ascending aorta may hit the wall more because of the movement of the aorta and thus more easily induce a retrograde type A dissection.…”

Section: Journal Of Vascular Surgerysupporting

confidence: 83%

A current systematic evaluation and meta-analysis of chimney graft technology in aortic arch diseases

Ahmad

Mylonas

Majd

et al. 2017

Journal of Vascular Surgery

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Section: Journal Of Vascular Surgerysupporting

confidence: 83%

A current systematic evaluation and meta-analysis of chimney graft technology in aortic arch diseases

Ahmad

Mylonas

Majd

et al. 2017

Journal of Vascular Surgery

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“…The largest multicentre series include up to 95 patients. 212 The 30-day mortality rate ranges between 0 and 29% (including elective and emergency cases). 213e215 The overall early patency rate of PGs ranges between 92% and 100%.…”

Section: Alternative Approachesmentioning

confidence: 99%

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

Czerny¹,

Schmidli²,

Adler³

et al. 2019

European Journal of Vascular and Endovascular Surgery

252

122

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“…Earlier data with shorter follow-up for 29 of these patients have been published previously inside a multicentre study. 8 Technical success was defined according to TEVAR reporting standards. 9 Outcomes measured included peri-operative mortality and morbidity, retrograde type A dissection, maximum aortic TD and aneurysm volume with post-operative evolution, endoleak, survival, freedom from re-interventions, and freedom from CPG occlusion during the follow-up.…”

Section: Methodsmentioning

confidence: 99%

“…A recent European experience of CPGs in SAB showed similar outcomes: the reported perioperative mortality, endoleak incidence, and neurological events were 9.5%, 10.5%, and 2%, respectively, in a cohort of 95 patients. 8 The retrospective analysis, the inclusion of different types of aortic disease, and the lack of a comparison group represent study limitations.…”

mentioning

confidence: 99%

Mid-term Results of Chimney and Periscope Grafts in Supra-aortic Branches in High Risk Patients

Pecoraro

Lachat

Cayne

et al. 2017

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThe use of chimney and periscope grafts for the treatment of aneurysms involving the supra-aortic branches is reported with mid-term follow-up. This tool uses off the shelf devices and it can be employed in the emergency setting. This single centre experience reports the use of self expandable covered stents for parallel graft construction with particular attention to a standardised technique. The limited experience and follow-up available allow the use of this technique in high risk patients unfit for conventional surgery.Purpose: Report mid-term outcomes of thoracic endovascular aneurysm repair (TEVAR) with chimney and periscope grafts (CPG) in supra-aortic branches (SAB). Methods: Retrospective analysis, from October 2009 to May 2014, of patients with aneurysms requiring TEVAR with zone 0/1/2 proximal landing in association with at least one CPG in the SAB. All patients were considered at high risk for conventional surgery. Peri-operative mortality and morbidity, retrograde type A dissection, maximum aortic transverse diameter (TD) and its post-operative evolution, endoleak, survival, freedom from cardiovascular re-interventions, and CPG freedom from occlusion during the follow-up were analysed. Results: Forty-one patients (28.05% EuroScore II) with thoraco-abdominal aortic aneurysm (17%), arch aneurysm (39%), descending aneurysm (34%), and aneurysm extending from the arch to the visceral aorta (10%) were included. Fifteen (37%) patients were treated non-electively. Fifty-nine SABs were treated with the CPG technique: one, two, three, and four CPG were employed in 71%, 19%, 5%, and 5% of patients, respectively. The proximal landing was in zone 0 in 49% of patients, zone 1 in 17%, and zone 2 in 34%. Technical success was 95%. Peri-operative complications and neurological events were registered in six (14.6%) patients and there were 5 deaths (12%). At a median follow-up of 21.2 (mean 22, SD 18; range 0e65) months, type I/III endoleaks were registered in three (7%) cases and re-intervention in six (15%) patients. A significant aneurysm sac shrinkage (p<.001) was reported at mean follow-up and no significant aneurysm sac increase (>5 mm). The estimated 2 year survival, freedom from re-intervention, freedom from endoleak, and freedom from branch occlusion were 75%, 77%, 86%, and 96%, respectively. Conclusion: The chimney and periscope grafts technique was shown to be safe in aortic aneurysm disease involving the supra aortic branches, even in an emergency setting using off the shelf devices. Mid-term follow-up results in this high risk population are good, but longer follow-up is mandatory before this technique is used in intermediate-risk patients. Ó

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European Multicenter Registry for the Performance of the Chimney/Snorkel Technique in the Treatment of Aortic Arch Pathologic Conditions

Abstract: The chimney technique in the aortic arch proved highly and predictably successful, with a low rate of reinterventions.

Cited by 88 publications

References 25 publications

A current systematic evaluation and meta-analysis of chimney graft technology in aortic arch diseases

A current systematic evaluation and meta-analysis of chimney graft technology in aortic arch diseases

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

Mid-term Results of Chimney and Periscope Grafts in Supra-aortic Branches in High Risk Patients

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