The Chimney Graft:A Technique for Preserving or Rescuing Aortic Branch Vessels in Stent-Graft Sealing Zones

Abstract

The use of chimney grafts is feasible in the renal and superior mesenteric arteries, as well as in the supra-aortic branches, to facilitate stent-graft repair of thoracic or abdominal aortic lesions with inadequate fixation zones.

Early Experience with the Endowedge Technique and Snorkel Technique for Endovascular Aneurysm Repair with Challenging Neck Anatomy

“…12,13) The advantage of the SnT is that the ready availability of conventional endograft components and peripheral stents has enabled the use of this technique for both urgent symptomatic and emergency ruptured aneurysms. Although it could be advocated that the SnT represents an easy and effective alternative to FBE, 14) the SnT remains a technical challenge.…”

“…The mechanism responsible for forming a seal around the chimney stents by closure of the so-called 'gutters' around the chimney stent is likely multifactorial. 12) The 'gutters' located between the aorta, the stents and the endograft might also be the origin of type Ia ELs. In our study, all EVAR with the EnT were with proximal necks ≥7 mm, and excluded AAAs without type Ia ELs.…”

Endotension: rupture of abdominal aortic aneurysm

“…The chimney technique enables the use of a standard off-the-shelf endoprosthesis to treat a lesion, with an inadequate fixation zone and it provides an alternative to a fenestrated stent graft in urgent cases and in aneurysms with challenging neck morphologies. This technique also enables the rebuilding of the side branches of the aorta that might have been involuntarily covered during the endovascular repair 1,7 .…”

“…The new technique (called 'chimney') is the percutaneous transluminal placement of a stent through the aortic visceral and renal branches 1 . A prosthesis is placed to exclude the thoracoabdominal aneurysm.…”

Infected Aortic Aneurysms

“…Although controversial, the artery of Adamkiewicz, normally located between T8 and L2, should be preserved if possible [100]. If essential branches of the aorta are to be covered by stent grafts, revascularization by either a bypass surgery, open debranching, or endovascular debranching with a chimney technique or a fenestrated stent graft is necessary [101][102][103][104][105]. Adjunctive procedures, such as open debridement and percutaneous drainage, could be performed, based on the clinical judgment [74].…”