Sage Journals: Discover world-class research

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

Get full access to this article

View all access options for this article.

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.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.16 MB

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:

Methods:

Results:

Conclusions:

Keywords

Get full access to this article

References

Supplementary Material