Triple-barrel Graft as a Novel Strategy to Preserve Supra-aortic Branches in Arch-TEVAR Procedures: Clinical Study and Systematic Review

Shahverdyan, Robert; Gawenda, M.; Brunkwall, Jan

doi:10.1016/j.ejvs.2012.09.023

Cited by 59 publications

(53 citation statements)

References 37 publications

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“…However, the long-term durability of hybrid procedures remains to be defined. Endovascular supra-arch branch preservation was successfully attempted using fenestrated, scalloped or branched stent grafts [4, 5], all of which have to be customized before implantation, limiting their applicability in emergent settings. Use of a chimney stent makes it possible to use standard off-the-shelf stent grafts to instantly treat lesions with inadequate sealing zones, providing an alternative in emergent cases [6, 7].…”

Section: Introductionmentioning

confidence: 99%

The chimney technique for preserving the left subclavian artery in thoracic endovascular aortic repair

Xue

Sun

Zheng

et al. 2014

European Journal of Cardio-Thoracic Surgery

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OBJECTIVESThe objective of the present study was to evaluate short- and mid-term outcomes of the left subclavian artery (LSA) chimney stent implantation (LSACSI) during thoracic endovascular aortic repair (TEVAR), and to summarize our experience with this technique.METHODSFrom June 2010 to September 2012, 59 patients (49 men; mean age of 57.4 ± 13.3 years, range from 26 to 83 years) who underwent TEVAR and LSACSI were enrolled. Patients suffered from Stanford type B aortic dissection (n = 27), penetrating aortic ulcer (n = 18), aortic arch aneurysm (n = 9), pseudoaneurysm of the aortic arch (n = 4) and proximal type I endoleak after TEVAR of aortic dissection (n = 1). Elective settings were performed in 72% and emergent in 38% of all patients. Follow-up was performed at postoperative 3 months, 6 months and yearly thereafter.RESULTSThe technical success rate was 98.3% (58/59), and 69 thoracic stent grafts were used. Sixty-two chimney stents, including 55 uncovered and 7 covered stents, were implanted in 59 LSAs. The overall immediate endoleak rate was 15.3% (9/59); type I endoleak was observed in 5 patients and type II in 4 patients. The difference in the immediate endoleak rate related to the anatomy between the outer and the inner curvature was statistically significant (35 vs 4%, P = 0.018). Chimney stent compression was observed in 3 patients and another stent was deployed inside the first one. Perioperative complications included stroke (3.4%, 2/59) and left upper limb ischaemia (1.7%, 1/59). The median follow-up period was 16.5 (range 1–39 months). The mortality rate during follow-up was 5.4% (3/56). Complications during follow-up included endoleak [overall, n = 8 (14.3%, 8/56); type I, n = 5; type II, n = 3], retrograde type A aortic dissection (n = 1), collapse (n = 3, 5.4%) or occlusion (n = 2, 3.6%) of the chimney stent.CONCLUSIONSShort- and mid-term results showed that it is feasible to preserve the patency of the LSA in TEVAR with the chimney technique for thoracic aortic pathologies close to the LSA. However, TEVAR combined with LSACSI was not advocated for lesions located at the outer curve of the aortic arch due to a high possibility of endoleak.

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Section: Introductionmentioning

confidence: 99%

The chimney technique for preserving the left subclavian artery in thoracic endovascular aortic repair

Xue

Sun

Zheng

et al. 2014

European Journal of Cardio-Thoracic Surgery

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“…Several options have been described that allow patency of the left SCA to be maintained, including preoperative left SCA revascularization by elective debranching before TEVAR, the hybrid repair by combining endovascular and open repair, the chimney technique by deploying a left SCA stent parallel to the thoracic endograft, prefabricated branched endograft deployment, or surgeon modified endografts [18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Postendovascular thoracic aortic repair subclavian steal syndrome revealed by severe headache

Mhamdi

Nakhli

Chelly

et al. 2015

Egyptian Journal of Anaesthesia

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Subclavian steal syndrome (SCSS) has been known since 1960 in the medical literature. Its principal cause is atherosclerosis responsible of occlusion of the subclavian artery (SCA). It is the pathological process in which blood flows in reverse direction from the vertebral artery (VA) to the SCA. Usually asymptomatic, but a variety of symptoms may develop involving the vertebro-basilar and/or the carotid territories and may be precipitated by exercise of the upper extremity. In some circumstances it can be iatrogenic complicating the course of a thoracic endovascular aortic repair (TEVAR) when the left SCA is covered by the endoprosthesis, which is a necessity many times giving the frequent proximity of the acute thoracic pathologies to the origin of this vessel. We present a case of severe headache occurring after a TEVAR with intentional coverage of the origin of the left SCA. This headache was the only symptom from which the patient complained, and which disappeared immediately after carotid-SCA bypass. Other devastating complications can happen, which gave as a concern about the management of SCA when decision to practice a TEVAR is taken.ª 2015 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Anesthesiologists.

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“…Reported treatment options for aortic arch pseudoaneurysms have included surgical grafts, ligation, pericardial roll graft replacement, embolization with coils, and the use of endovascular stent grafts combined with surgical treatment [1-7,9]. The conventional open surgery was gradually replaced by endovascular treatment due to the complexity of the surgery, surgical trauma and high associated mortality rate.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports that we have identified in English literature included conventional surgical repair, hybrid surgery,embolization of an aortic arch pseudoaneurysm with detachable coils and total endovascular debranching of the aortic arch or double-chimney technique [1-7]. Conventional surgical intervention requires a thoracotomy, cardiopulmonary bypass, hypothermic circulatory arrest and aortic cross-clamping, remains a surgical challenge with a high rate of mortality (7-17%) and neurologic complication (4-12%) [1,2,8].…”

Section: Introductionmentioning

confidence: 99%

Endovascular repair of an aortic arch pseudoaneurysm with double chimney stent grafts: a case report

Zhou

Qiu

2013

J Cardiothorac Surg

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Aortic arch pseudoaneurysm is a rare condition but carries a high risk of rupture. We report a case of a 45-year-old man with aortic arch pseudoaneurysm between left common carotid artery (LCCA) and left subclavian artery (LSA), in which a endovascular stent graft combined with double chimneys covered stents were successfully placed. There were no any complaints and complications after 12 months follow-up. The CTA demonstrated thrombus formation in the pseudoaneurysm lumen, no endoleak and the aortic arch, LCCA and LSA were all patent. We feel that the combined endovascular and double chimneys may be a valuable therapeutic alternative when treating aortic arch lesion. However, long-term clinical efficacy and safety have yet to be confirmed.

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Triple-barrel Graft as a Novel Strategy to Preserve Supra-aortic Branches in Arch-TEVAR Procedures: Clinical Study and Systematic Review

Abstract: The use of double chimney-grafts is possible in high-risk patients where the proximal landing zone of endograft would be in zone 0. The available data is still limited. The long-term follow-up remains to be evaluated with the increased number of patients treated.

Cited by 59 publications

References 37 publications

The chimney technique for preserving the left subclavian artery in thoracic endovascular aortic repair

The chimney technique for preserving the left subclavian artery in thoracic endovascular aortic repair

Postendovascular thoracic aortic repair subclavian steal syndrome revealed by severe headache

Endovascular repair of an aortic arch pseudoaneurysm with double chimney stent grafts: a case report

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