Long-Term Outcome of Chimney Technique Using a Balloon-Expandable Bare-Metal Stent to Preserve Supra-Arch Branches in Type B Aortic Dissection

Abstract

Purpose:

This study was performed to investigate the long-term effect of chimney technique using balloon-expandable bare-metal stents (BMSs) to preserve the supra-arch branches in type B aortic dissection (TBAD).

Methods:

Fifty patients with TBAD treated by thoracic endovascular aortic repair with the chimney technique (chTEVAR) using balloon-expandable BMSs from July 2009 to December 2013 were retrospectively assessed. Follow-up computed tomography angiography was performed to assess the postoperative outcomes. The primary end point was a persistent type Ia endoleak (ELIa). The secondary endpoints were chimney stent (CS)-based complications (stenosis, occlusion, fracture, or transposition), all-cause mortality, reintervention, and stroke.

Results:

Fifty supra-arch branches (left common carotid artery, n = 11; left subclavian artery, n = 39) were preserved via the chimney technique with 50 balloon-expandable BMSs. The technical success rate was 100%. An immediate ELIa was discovered in 9 (18%) patients. The median survival duration during follow-up was 77.3 months. Five (10%) patients had a persistent ELIa; 3 of these patients had an immediate ELIa. Asymptomatic CS-based complications were found in 3 (6%) patients. The all-cause mortality rate was 8% (4/50); 2 deaths were aortic-related deaths. Five (10%) patients underwent a reintervention. During the estimated 36-month survival period, the survival rate, the rate of freedom from persistent ELIa, and the rate of freedom from reintervention were 93.87%, 89.48%, and 95.56%, respectively.

Conclusions:

The long-term outcomes showed that chTEVAR using balloon-expandable BMSs was safe and feasible for preservation of the supra-arch branches. Evaluation of more patients with a longer follow-up period is needed.

Keywords

type B aortic dissection thoracic endovascular aortic repair chimney technique endoleak bare stent

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References

Nienaber

Kische

Rousseau

, et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013;6(4):407–416.

Fattori

Montgomery

Lovato

, et al. Survival after endovascular therapy in patients with type B aortic dissection: a report from the International Registry of Acute Aortic Dissection (IRAD). JACC Cardiovasc Interv. 2013;6(8):876–882.

Lotfi

Clough

Ali

, et al. Hybrid repair of complex thoracic aortic arch pathology: long-term outcomes of extra-anatomic bypass grafting of the supra-aortic trunk. Cardiovasc Intervent Radiol. 2012;36(1):46–55.

Antoniou

El Sakka

Hamady

Wolfe

. Hybrid treatment of complex aortic arch disease with supra-aortic debranching and endovascular stent graft repair. Eur J Vasc Endovasc Surg. 2010;39(6):683–690.

Qin

Zhao

Wang

, et al. In situ laser fenestration is a feasible method for revascularization of aortic arch during thoracic endovascular aortic repair. J Am Heart Assoc. 2017;6(4):9.

Tazaki

Inoue

Higami

, et al. Thoracic endovascular aortic repair with branched Inoue stent graft for arch aortic aneurysms. J Vasc Surg. 2017;66(5):1340–1348. e1345.

Huang

Jiao

Zhang

, et al. Implantation of unibody single-branched stent graft for patients with type B aortic dissections involving the left subclavian artery: 1-year follow-up outcomes. Cardiovasc Intervent Radiol. 2017;40(11):1678–1686.

Wang

Shu

, et al. Thoracic endovascular aortic repair with single/double chimney technique for aortic arch pathologies. J Endovasc Ther. 2017;24(3):383–393.

Ding

Liu

Xie

, et al. Outcomes of chimney technique for preservation of the left subclavian artery in type B aortic dissection. Eur J Vasc Endovasc Surg. 2019;57(3):374–381.

10.

Zhu

Guo

Liu

Jia

Xiong

Wang

. The single-centre experience of the supra-arch chimney technique in endovascular repair of type B aortic dissections. Eur J Vasc Endovasc Surg. 2013;45(6):633–638.

11.

Xue

Sun

Zheng

, et al. The chimney technique for preserving the left subclavian artery in thoracic endovascular aortic repair. Eur J Cardiothorac Surg. 2015;47(4):623–629.

12.

Criado

. Chimney grafts and bare stents: aortic branch preservation revisited. J Endovasc Ther. 2007;14(6):823–824.

13.

Bosanquet

Twine

Tang

, et al. Pragmatic minimum reporting standards for thoracic endovascular aortic repair. J Endovasc Ther. 2015;22(3):356–367.

14.

Criado

. A percutaneous technique for preservation of arch branch patency during thoracic endovascular aortic repair (TEVAR): retrograde catheterization and stenting. J Endovasc Ther. 2007;14(1):54–58.

15.

Huang

Yang

Luo

, et al. Outcomes and morphologic changes of immediate type Ia endoleak following endovascular repair of acute type B aortic dissection. Ann Vasc Surg. 2015;29(2):174–182.

16.

Bosiers

Donas

Mangialardi

, et al. European multicenter registry for the performance of the chimney/snorkel technique in the treatment of aortic arch pathologic conditions. Ann Thorac Surg. 2016;101(6):2224–2230.

17.

Huang

Tang

Qiao

Liu

Zhou

. Early results of chimney technique for type B aortic dissections extending to the aortic arch. Cardiovasc Intervent Radiol. 2016;39 (1):28–35.

18.

Ahmad

Mylonas

Majd

Brunkwall

. A current systematic evaluation and meta-analysis of chimney graft technology in aortic arch diseases. J Vasc Surg. 2017;66(5):1602–1610. e1602.

19.

Shahverdyan

Gawenda

Brunkwall

. Triple-barrel graft as a novel strategy to preserve supra-aortic branches in arch-TEVAR procedures: clinical study and systematic review. Eur J Vasc Endovasc Surg. 2013;45(1):28–35.

20.

Mangialardi

Serrao

Kasemi

Alberti

Fazzini

Ronchey

. Chimney technique for aortic arch pathologies: an 11-year single-center experience. J Endovasc Ther. 2014;21(2):312–323.

21.

Zhao

Shi

Wang

, et al. Chimney technique in supra-aortic branch reconstruction in China: a systematic and critical review of Chinese published experience. Vasc Endovascular Surg. 2017;51(6):429–435.

22.

Bin Jabr

Lindblad

Dias

Resch

Malina

. Efficacy and durability of the chimney graft technique in urgent and complex thoracic endovascular aortic repair. J Vasc Surg. 2015;61(4):886–894. e881.

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