Single-center mid-term experience with chimney-graft technique for the preservation of flow to the supra-aortic branches. (April 2018)

• Record Type: Journal Article
• Authors: Shahverdyan, Robert; Mylonas, Spyridon; Gawenda, Michael; Brunkwall, Jan
• Is Part Of: Vascular. Volume 26:Number 2(2018)
• Page Start: 175
• Page End: 182
• Publication Date: 2018-04
• Subjects: Endovascular repair -- aortic arch -- aneurysm -- chimney grafts; 616.13
• DOI: 10.1177/1708538117723200
• Languages: English
• ISSNs: 1708-5381

Abstract

Objectives: To investigate the feasibility and the mid-term outcomes of the chimney-graft technique for the revascularization of supra-aortic branches in patients with thoracic aortic pathologies involving the aortic arch. Methods: A retrospective analysis of a prospectively maintained database between January 2010 and July 2016 was performed. Primary endpoints were 30-day and overall mortality. Secondary endpoints were technical success, target vessel patency, stroke/transitory ischemic attack and type I/III endoleak rate. Results: A total of 30 patients (80% male, median age 70.0 years) were treated using the chimney-graft technique for the supra-aortic branches. The indication was a degenerative aneurysm in nine patients (32%) and a type B Stanford aortic dissection and a penetrating aortic ulcer in the descending aorta in seven patients (23%), respectively. In six patients (20.0%), the indication was an type Ia endoleak after previous endovascular thoracic repair, whereas a pseudoaneurysm after previous open repair of the descending aorta was the indication in one patient (3%). Twenty-three patients (77%) were treated electively, five (17%) emergently and two (7%) urgently because of free rupture. Technical success was achieved in 90% of patients. The 30-day/in-hospital mortality was 17% (5/30). A retrograde dissection was presented in five patients. Four patients experienced a cerebrovascular event. Eight patients had type Ia endoleak and 10 had type II. During the median follow-up of 16 months (range: 0–56), four further patients died: one in respiratory insufficiency, one due to a ruptured abdominal aortic aneurysm, one in meningitis and the last one for unknown reason. The chimney-graft patency was 100%. According to the Kaplan–Meier curve, the estimated survival at one year was 66 ± 9%. Conclusions: The chimney-graft technique, despite a technically demanding strategy, is a useful tool as bailout procedure in our armamentarium for high-risk patients, unsuitable for open or hybrid repair.