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Chimney grafts preserve visceral flow and allow safe stenting of juxtarenal aortic occlusion.

Bin Jabr, Adel; Sonesson, Björn LU ; Lindblad, Bengt LU ; Dias, Nuno LU ; Resch, Tim LU and Malina, Martin LU (2012) In Journal of Vascular Surgery
Abstract
OBJECTIVE: Chimney grafts have proven useful for urgent endovascular repair of juxtarenal aortic aneurysms. Stenting of juxtarenal aortic occlusive disease is not routinely advocated due to the risk of visceral artery obstruction. We report on the potential applicability of chimney grafts in 10 patients with juxtarenal aortic stenosis or occlusion. To our best knowledge, chimney grafts have not been applied previously in this challenging setting. METHODS: Ten high-risk female patients (mean age, 68 years) with severe stenosis or occlusion of the aorta at the level of the visceral arteries were offered stenting. "Chimney" stents or stent grafts (20-40 mm long) were implanted from a brachial approach into visceral arteries that needed to be... (More)
OBJECTIVE: Chimney grafts have proven useful for urgent endovascular repair of juxtarenal aortic aneurysms. Stenting of juxtarenal aortic occlusive disease is not routinely advocated due to the risk of visceral artery obstruction. We report on the potential applicability of chimney grafts in 10 patients with juxtarenal aortic stenosis or occlusion. To our best knowledge, chimney grafts have not been applied previously in this challenging setting. METHODS: Ten high-risk female patients (mean age, 68 years) with severe stenosis or occlusion of the aorta at the level of the visceral arteries were offered stenting. "Chimney" stents or stent grafts (20-40 mm long) were implanted from a brachial approach into visceral arteries that needed to be covered by the aortic stent. The chimney stents were then temporarily obstructed by balloon catheters to prevent visceral embolization until the aortic stent or stent graft was deployed. RESULTS: All procedures were technically successful, and patency was obtained in all visceral arteries and the aorta without distal embolization. One patient died after 9 days of acute heart failure. The nine surviving patients presented no complications, and all stented vessels remained patent at up to 6 years. Another patient died after 5.5 years due to lung cancer. All three patients with renal impairment have improved renal function, and a reduction in antihypertensive medication has been possible. CONCLUSIONS: Chimney grafts may allow stenting of juxtarenal aortic occlusive disease by protecting the patency of visceral arteries. Further evaluation with more patients and longer follow-up is required. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Vascular Surgery
publisher
Mosby
external identifiers
  • WOS:000313750800014
  • PMID:23219515
  • Scopus:84872676736
ISSN
1097-6809
DOI
10.1016/j.jvs.2012.08.108
language
English
LU publication?
yes
id
6b1663e3-b464-44b9-a21a-92a05cda4010 (old id 3347503)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/23219515?dopt=Abstract
date added to LUP
2013-01-02 14:30:48
date last changed
2016-10-23 04:33:02
@misc{6b1663e3-b464-44b9-a21a-92a05cda4010,
  abstract     = {OBJECTIVE: Chimney grafts have proven useful for urgent endovascular repair of juxtarenal aortic aneurysms. Stenting of juxtarenal aortic occlusive disease is not routinely advocated due to the risk of visceral artery obstruction. We report on the potential applicability of chimney grafts in 10 patients with juxtarenal aortic stenosis or occlusion. To our best knowledge, chimney grafts have not been applied previously in this challenging setting. METHODS: Ten high-risk female patients (mean age, 68 years) with severe stenosis or occlusion of the aorta at the level of the visceral arteries were offered stenting. "Chimney" stents or stent grafts (20-40 mm long) were implanted from a brachial approach into visceral arteries that needed to be covered by the aortic stent. The chimney stents were then temporarily obstructed by balloon catheters to prevent visceral embolization until the aortic stent or stent graft was deployed. RESULTS: All procedures were technically successful, and patency was obtained in all visceral arteries and the aorta without distal embolization. One patient died after 9 days of acute heart failure. The nine surviving patients presented no complications, and all stented vessels remained patent at up to 6 years. Another patient died after 5.5 years due to lung cancer. All three patients with renal impairment have improved renal function, and a reduction in antihypertensive medication has been possible. CONCLUSIONS: Chimney grafts may allow stenting of juxtarenal aortic occlusive disease by protecting the patency of visceral arteries. Further evaluation with more patients and longer follow-up is required.},
  author       = {Bin Jabr, Adel and Sonesson, Björn and Lindblad, Bengt and Dias, Nuno and Resch, Tim and Malina, Martin},
  issn         = {1097-6809},
  language     = {eng},
  month        = {12},
  publisher    = {ARRAY(0xb16f428)},
  series       = {Journal of Vascular Surgery},
  title        = {Chimney grafts preserve visceral flow and allow safe stenting of juxtarenal aortic occlusion.},
  url          = {http://dx.doi.org/10.1016/j.jvs.2012.08.108},
  year         = {2012},
}