Michel J Bosiers1, Konstantinos P Donas2, Nicola Mangialardi3, Giovanni Torsello1, Vincent Riambau4, Frank J Criado5, Frank J Veith6, Sonia Ronchey3, Stefano Fazzini3, Mario Lachat7. 1. Department of Vascular and Endovascular Surgery, University of Münster, Münster; Department of Vascular Surgery, St. Franziskus-Hospital Münster, Münster, Germany. 2. Department of Vascular and Endovascular Surgery, University of Münster, Münster; Department of Vascular Surgery, St. Franziskus-Hospital Münster, Münster, Germany. Electronic address: konstantinos.donas@googlemail.com. 3. Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy. 4. Vascular Access Unit, Vascular Surgery Division, Thorax Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain. 5. Division of Vascular Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland. 6. Division of Vascular Surgery, New York University Langone Medical Center, New York, New York; Department of Vascular Surgery, The Cleveland Clinic, Cleveland, Ohio. 7. Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland.
Abstract
BACKGROUND: To study the performance of the chimney technique in the treatment of aortic arch pathologic conditions. METHODS: We retrospectively evaluated the clinical and procedural outcome data of patients undergoing endovascular treatment in the aortic arch by use of the chimney technique at four European centers between June 2002 and December 2014. The primary endpoint was technical success. The secondary endpoints were type I endoleak, 30-day mortality, stroke, primary patency of the chimney graft, and freedom from reintervention. RESULTS: Ninety-five patients were included in the study. The underlying pathologic conditions were degenerative aneurysm (n = 45, 47.4%), type B aortic dissection (n = 30, 31.6%), dissecting aneurysm (n = 6, 6.5%), penetrating atherosclerotic ulcer (n = 5, 5.3%), type I endoleak after previous thoracic endovascular aortic repair (n = 6, 6.3%), and aortic embolic disease (n = 3, 3.2%). Twenty-one patients (22%) underwent arch-branch debranching before chimney graft implantation. The majority of patients were treated electively (n = 49, 51.6%). Forty-six patients (48.4%) underwent urgent placement of chimney grafts because of their symptoms (n = 25) or rupture (n = 21). Technical success was 89.5%. The 30-day mortality was 9.5% (9 patients). No aorta-related death was observed. A type Ia endoleak occurred in 10 patients (10.5%) intraoperatively, resolving spontaneously within the first 30 days in 50% of these cases. Major stroke was diagnosed in 2 patients (2%). Primary patency of the chimney grafts was 98%, and 5 patients (5.2%) required a reintervention. CONCLUSIONS: The chimney technique in the aortic arch proved highly and predictably successful, with a low rate of reinterventions.
BACKGROUND: To study the performance of the chimney technique in the treatment of aortic arch pathologic conditions. METHODS: We retrospectively evaluated the clinical and procedural outcome data of patients undergoing endovascular treatment in the aortic arch by use of the chimney technique at four European centers between June 2002 and December 2014. The primary endpoint was technical success. The secondary endpoints were type I endoleak, 30-day mortality, stroke, primary patency of the chimney graft, and freedom from reintervention. RESULTS: Ninety-five patients were included in the study. The underlying pathologic conditions were degenerative aneurysm (n = 45, 47.4%), type B aortic dissection (n = 30, 31.6%), dissecting aneurysm (n = 6, 6.5%), penetrating atherosclerotic ulcer (n = 5, 5.3%), type I endoleak after previous thoracic endovascular aortic repair (n = 6, 6.3%), and aortic embolic disease (n = 3, 3.2%). Twenty-one patients (22%) underwent arch-branch debranching before chimney graft implantation. The majority of patients were treated electively (n = 49, 51.6%). Forty-six patients (48.4%) underwent urgent placement of chimney grafts because of their symptoms (n = 25) or rupture (n = 21). Technical success was 89.5%. The 30-day mortality was 9.5% (9 patients). No aorta-related death was observed. A type Ia endoleak occurred in 10 patients (10.5%) intraoperatively, resolving spontaneously within the first 30 days in 50% of these cases. Major stroke was diagnosed in 2 patients (2%). Primary patency of the chimney grafts was 98%, and 5 patients (5.2%) required a reintervention. CONCLUSIONS: The chimney technique in the aortic arch proved highly and predictably successful, with a low rate of reinterventions.