Tun Wang1, Chang Shu2, Quan-Ming Li1, Ming Li1, Xin Li1, Hao He1, Alan Dardik3, Jian Qiu1. 1. Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China; Angiopathy Institute of Central South University, Changsha, China. 2. Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China; Angiopathy Institute of Central South University, Changsha, China; Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China. Electronic address: changshu_vascular@163.com. 3. Department of Surgery, Yale University School of Medicine, New Haven, Conn.
Abstract
OBJECTIVE: The objective of this study was to summarize our initial experience using the double chimney technique to treat aortic arch diseases. METHODS: From December 2009 to October 2016, 23 patients with aortic arch diseases, including 20 acute aortic dissections, 2 aortic arch aneurysms, and 1 type I endoleak after thoracic endovascular aortic repair (TEVAR), were treated using a double chimney technique. An emergent operation was performed in only one patient with an acute aortic dissection for severe left lower extremity ischemia. All patients were observed after TEVAR with computed tomography scans at 2 weeks, at 3 and 6 months, and annually thereafter. RESULTS: In all patients, aortic arch lesions were covered, and supra-aortic branches were patent without morbidity. In 22 patients, the innominate artery (IA) and left common carotid artery were reconstructed with the proximal landing zone in zone 0; in 1 patient, the left common carotid artery and left subclavian artery were reconstructed. During the procedure, there were three (13.0%) type I endoleaks. Chimney stent graft migration occurred in one (4.3%) patient perioperatively; compression of a chimney stent graft occurred in one (4.3%) patient 4 days after TEVAR. There were no type II endoleaks or perioperative mortality. Median follow-up was 28.0 ± 19.8 (range, 3-84) months, with no TEVAR-related deaths. Partial compression of the chimney stent graft in the IA occurred at 3 months after TEVAR in one (4.3%) patient; three patients had persistent but asymptomatic type I endoleaks. CONCLUSIONS: TEVAR using a double chimney technique to reconstruct the supra-aortic branches provides a safe and minimally invasive alternative procedure associated with low postoperative mortality. The main perioperative complications include type I endoleak and compression of the chimney stent grafts in the IA. More experience with long-term results is needed to evaluate the effectiveness and durability of this advanced endovascular procedure.
OBJECTIVE: The objective of this study was to summarize our initial experience using the double chimney technique to treat aortic arch diseases. METHODS: From December 2009 to October 2016, 23 patients with aortic arch diseases, including 20 acute aortic dissections, 2 aortic arch aneurysms, and 1 type I endoleak after thoracic endovascular aortic repair (TEVAR), were treated using a double chimney technique. An emergent operation was performed in only one patient with an acute aortic dissection for severe left lower extremity ischemia. All patients were observed after TEVAR with computed tomography scans at 2 weeks, at 3 and 6 months, and annually thereafter. RESULTS: In all patients, aortic arch lesions were covered, and supra-aortic branches were patent without morbidity. In 22 patients, the innominate artery (IA) and left common carotid artery were reconstructed with the proximal landing zone in zone 0; in 1 patient, the left common carotid artery and left subclavian artery were reconstructed. During the procedure, there were three (13.0%) type I endoleaks. Chimney stent graft migration occurred in one (4.3%) patient perioperatively; compression of a chimney stent graft occurred in one (4.3%) patient 4 days after TEVAR. There were no type II endoleaks or perioperative mortality. Median follow-up was 28.0 ± 19.8 (range, 3-84) months, with no TEVAR-related deaths. Partial compression of the chimney stent graft in the IA occurred at 3 months after TEVAR in one (4.3%) patient; three patients had persistent but asymptomatic type I endoleaks. CONCLUSIONS:TEVAR using a double chimney technique to reconstruct the supra-aortic branches provides a safe and minimally invasive alternative procedure associated with low postoperative mortality. The main perioperative complications include type I endoleak and compression of the chimney stent grafts in the IA. More experience with long-term results is needed to evaluate the effectiveness and durability of this advanced endovascular procedure.
Authors: Jiehua Li; Yunfei Xue; Shangqian Li; Likun Sun; Lunchang Wang; Tun Wang; Kun Fang; Mingyao Luo; Xin Li; Hao He; Ming Li; Quanming Li; Alan Dardik; Chang Shu Journal: Front Cardiovasc Med Date: 2022-08-04