Yuxi Zhao1, Jiaxuan Feng2, Xiaonan Yan3, Guoxian Zhu4, Jian Zhou1, Zhenjiang Li1, Rui Feng5, Zaiping Jing6. 1. Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China. 2. Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China. Electronic address: fengjiaxuan01@163.com. 3. Department of Gastroenterology, Evidence Based Medicine Research Center, Changhai Hospital, Navy Medical University, Shanghai, China. 4. Department of Vascular Surgery, First Affiliated Hospital of Shenzhen University, Shenzhen Second Hospital, Guangdong, China. 5. Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China. Electronic address: webmaster@xueguan.net. 6. Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China. Electronic address: jingzp@xueguan.net.
Abstract
BACKGROUND: The results of different chimney techniques in different zones of aortic arch were analyzed, so as to provide clues to decrease the complications of chimney thoracic endovascular repair (cTEVAR). METHODS: Between April 2012 and April 2017, 234 patients with aortic dissection involving arch branches received cTEVAR. Among these patients, 156 (66.7%) received single chimney (SC), 48 (20.5%) received double chimneys (DCs), and 30 (12.8%) received triple chimneys (TCs). A total of 342 chimney grafts (CGs) were used. RESULTS: All chimney grafts were successfully implanted, and no migration or occlusion was observed during follow-up. Mortality of this cohort was 1.7% (4/234). Three (3/234, 1.3%) patients suffered from cerebral vascular events. Seventy-five (75/234, 32.1%) had intraoperative type I endoleak. Twenty-seven (27/75, 36.0%) of them were found to have automatically disappeared in the follow-up period. The false lumens of 33 (33/75, 44.0%) were found to be stable, and 15 (15/75, 20%) were found to have expanded and were successfully retreated by endoleak embolization. The proximal tear located in zone 0 had higher instant endoleak rate than zone 1, zone 2, and zone 3 (P = 0.041; P = 0.042; P = 0.009). TC were found to have more instant endoleak than SC (P < 0.001) and DC (P = 0.012). But in the follow-up period, there was no significant difference. CONCLUSIONS: TCs and the proximal tear locating in zone 0 were found to be with higher instant endoleak rate, and it may need more rigorous follow-up. Some of the endoleak after cTEVAR could automatically disappear and some could be completely re-treated by gutter embolization procedure.
BACKGROUND: The results of different chimney techniques in different zones of aortic arch were analyzed, so as to provide clues to decrease the complications of chimney thoracic endovascular repair (cTEVAR). METHODS: Between April 2012 and April 2017, 234 patients with aortic dissection involving arch branches received cTEVAR. Among these patients, 156 (66.7%) received single chimney (SC), 48 (20.5%) received double chimneys (DCs), and 30 (12.8%) received triple chimneys (TCs). A total of 342 chimney grafts (CGs) were used. RESULTS: All chimney grafts were successfully implanted, and no migration or occlusion was observed during follow-up. Mortality of this cohort was 1.7% (4/234). Three (3/234, 1.3%) patients suffered from cerebral vascular events. Seventy-five (75/234, 32.1%) had intraoperative type I endoleak. Twenty-seven (27/75, 36.0%) of them were found to have automatically disappeared in the follow-up period. The false lumens of 33 (33/75, 44.0%) were found to be stable, and 15 (15/75, 20%) were found to have expanded and were successfully retreated by endoleak embolization. The proximal tear located in zone 0 had higher instant endoleak rate than zone 1, zone 2, and zone 3 (P = 0.041; P = 0.042; P = 0.009). TC were found to have more instant endoleak than SC (P < 0.001) and DC (P = 0.012). But in the follow-up period, there was no significant difference. CONCLUSIONS:TCs and the proximal tear locating in zone 0 were found to be with higher instant endoleak rate, and it may need more rigorous follow-up. Some of the endoleak after cTEVAR could automatically disappear and some could be completely re-treated by gutter embolization 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