The Single-centre Experience of the Supra-arch Chimney Technique in Endovascular Repair of Type B Aortic Dissections

Zhu, Yating; Guo, Wei; Liu, X.; Jia, Xin; Xiong, Jiang; Wang, L.

doi:10.1016/j.ejvs.2013.02.016

Cited by 55 publications

(71 citation statements)

References 18 publications

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“…In this study, the procedure of all 27 patients was technically successful, similar to previous studies [12]. In three cases, the aortic endograft had to be deployed into Zone 0 to obtain an adequate proximal landing zone.…”

Section: Discussionmentioning

confidence: 51%

“…This technique, firstly performed in 2002, was thought to be a ''bailout'' option to rescue inadvertently covered vessels, and the follow-up observation proved the good results of this alternative [14,16]. This technique was then used even in planned procedures for patients considered unsuitable for open repair [12,17]. Its relatively easy procedure, familiar to most practicing surgeons, has shown its potential advantages and has been reported by increasingly more literature [3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…However, in aortic dissections, this technique might be substantially different from that in aneurysm repairs owing to anatomical and pathophysiologic differences. Regarding the application of chimney grafts in aortic dissection, reports have been limited to small series with relatively short follow-up [12][13][14][15], and no study has focused specially on aortic remodeling with this technique. In this study, we summarize our initial experience with the chimney technique and evaluate the follow-up aortic remodeling for TBAD extending to the aortic arch.…”

Section: Introductionmentioning

confidence: 99%

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Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

Huang

Tang

Qiao

et al. 2015

Cardiovasc Intervent Radiol

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Objective To summarize our early experience gained from the chimney technique for type B aortic dissection (TBAD) extending to the aortic arch and to evaluate the aortic remodeling in the follow-up period. Methods From September 2011 to July 2014, 27 consecutive TBAD patients without adequate proximal landing zones were retrograde analyzed. Chimney stent-grafts were deployed parallel to the main endografts to reserve flow to branch vessels while extending the landing zones. In the follow-up period, aortic remodeling was observed with computed tomography angiography. Results The technical success rate was 100 %, and endografts were deployed in zone 0 (n = 3, 11.1 %), zone 1 (n = 18, 66.7 %), and zone 2 (n = 6, 22.2 %). Immediately, proximal endoleaks were detected in 5 patients (18.5 %). During a mean follow-up period of 17.6 months, computed tomography angiography showed all the aortic stent-grafts and chimney grafts to be patent. Favorable remodeling was observed at the level of maximum descending aorta and left subclavian artery with expansion of true lumen (from 18.4 ± 4.8 to 25 ± 0.86 mm, p \ 0.001 and 27.1 ± 0.62 to 28.5 ± 0.37 mm, p \ 0.001) and depressurization of false lumen (from 23.7 ± 2.7 to 8.7 ± 3.8 mm, p \ 0.001, from 5.3 ± 1.2 to 2.1 ± 2.1 mm, p \ 0.001). While at the level of maximum abdominal aorta, suboptimal remodeling of the total aorta (from 24.1 ± 0.4 to 23.6 ± 1.5 mm, p = 0.06) and true lumen (from 13.8 ± 0.6 to 14.5 ± 0.4 mm, p = 0.08) was observed. Conclusion Based on our limited experience, the chimney technique with thoracic endovascular repair is demonstrated to be promising for TBAD extending to the arch with favorable aortic remodeling.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

Huang

Tang

Qiao

et al. 2015

Cardiovasc Intervent Radiol

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“…13,23,24 In this study, the overall incidence of type Ia endoleak was 10.7%, better than other studies with either covered or bare stents. 10,12 Most of our patients had aortic dissection, which without the degenerative process and dilated aortic lumen of aortic aneurysm is associated with lower rates of intraoperative and late endoleak. 25 The double chimney technique in the aortic arch is still controversial.…”

Section: Discussionmentioning

confidence: 99%

“…8 Its role in emergent TEVAR is becoming widely accepted, and in elective TEVAR, the planned use of the chimney technique has the potential to supplant hybrid techniques in the treatment of aortic arch diseases, 9,10 although the long-term efficacy of arch chimneys is still not known.…”

Section: Introductionmentioning

confidence: 99%

Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies

Wang

Shu

et al. 2017

J Endovasc Ther

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Purpose: To summarize a single-center experience using the single/double chimney technique in association with thoracic endovascular aortic repairs (TEVAR) for aortic arch pathologies. Methods: From November 2007 to March 2016, 122 patients (mean age 50.4±12.7 years, range 29-80; 92 men) with aortic arch pathologies underwent TEVAR combined with single (n=101) or double (n=21) chimney grafts to reconstruct the supra-aortic branches: 21 innominate arteries, 114 left common carotid arteries, and 8 left subclavian arteries (LSA). Pathologies included type B aortic dissection (n=47), aortic arch dissection (n=49), retrograde type A aortic dissection (n=8), thoracic aortic aneurysm (n=7), penetrating aortic arch ulcer (n=9), and post-TEVAR type I endoleak (n=2). Follow-up examinations included computed tomography at 0.5, 3, 6, and 12 months and yearly thereafter. Results: The aortic stent-grafts were deployed in zone 0 (n=21), zone 1 (n=93), and zone 2 (n=8). One (0.8%) of the 122 patients died at 4 days due to a perforated peptic ulcer. Type Ia endoleaks were found intraoperatively in 13 (10.7%) patients, including 3 with the double chimney technique. Type II endoleaks occurred in 6 (4.9%) patients; 3 were treated with duct occluders in the LSA. Postoperative chimney graft migration occurred in 1 (0.8%) patient with double chimneys; additional stent-grafts were deployed in both chimneys. Median follow-up was 32.3 months, during which 1 (0.8%) patient died after a stroke at 3 months. Chimney stent-graft patency was observed in the remaining 120 patients. Two (1.7%) secondary TEVARs were performed for distal aortic dissection. Nine asymptomatic type Ia endoleaks and 1 type II endoleak persisted in follow-up; a type II endoleak in 1 patient with Marfan syndrome sealed in 52 months. Conclusion: TEVAR with the chimney technique provides a safe, minimally invasive alternative with good chimney graft patency and low postoperative mortality during midterm follow-up. The double chimney technique should be used judiciously owing to its potential complications.

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Thoracic Aortic Dissections

Wheatley

2014

Urgent Interventional Therapies

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The Single-centre Experience of the Supra-arch Chimney Technique in Endovascular Repair of Type B Aortic Dissections

Cited by 55 publications

References 18 publications

Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies

Thoracic Aortic Dissections

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