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The applicability of chimney grafts in the aortic arch.

Sugiura, K ; Sonesson, Björn LU ; Akesson, M ; Björses, Katarina LU ; Holst, Jan LU and Malina, Martin LU (2009) In Journal of Cardiovascular Surgery 50(4). p.475-481
Abstract
AIM: Proximal fixation is often limiting for thoracic endovascular aortic repair (TEVAR) and the stent graft may need to cover the origin of the arch branch vessels. Chimney grafts have been proposed to preserve flow into over stented branches during urgent TEVAR. The aim of this report is to share our initial experience of this technique. METHODS: Eleven patients underwent urgent TEVAR combined with a chimney graft between January 2004 and April 2009. The indications included acute complicated type B dissection (N.=2), ruptured aneurysms of the aortic arch (1) and descending aorta (2), traumatic aortic transaction (1), aortoesophageal fistula (1) and accidental over stenting of the left carotid artery during TEVAR (4). Chimney grafts were... (More)
AIM: Proximal fixation is often limiting for thoracic endovascular aortic repair (TEVAR) and the stent graft may need to cover the origin of the arch branch vessels. Chimney grafts have been proposed to preserve flow into over stented branches during urgent TEVAR. The aim of this report is to share our initial experience of this technique. METHODS: Eleven patients underwent urgent TEVAR combined with a chimney graft between January 2004 and April 2009. The indications included acute complicated type B dissection (N.=2), ruptured aneurysms of the aortic arch (1) and descending aorta (2), traumatic aortic transaction (1), aortoesophageal fistula (1) and accidental over stenting of the left carotid artery during TEVAR (4). Chimney grafts were implanted into the innominate (N.=3), left carotid (7) and left subclavian (1) arteries. Mean length of follow up was 20 months. RESULTS: All chimney grafts were successfully implanted. Two patients developed a primary proximal type I endoleak: one leak was successfully coil embolized, the other awaits treatment. One paraplegia was reversed by spinal drainage but two months later, this patient presented with a contained rupture and underwent successful conversion to open repair. No other postoperative aneurysm expansion has occurred and the chimney grafts remain patent. The only aneurysm related death occurred in a patient with an unrecognized chronic occlusion of his right carotid artery who received a left carotid chimney graft and suffered from a lethal stroke. CONCLUSIONS: Chimney grafts in the supra-aortic branches seem feasible and may facilitate urgent TEVAR in patients with an inadequate proximal neck. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Cardiovascular Surgery
volume
50
issue
4
pages
475 - 481
publisher
Edizioni Minerva Medica
external identifiers
  • wos:000271955000006
  • pmid:19734832
  • scopus:70450194407
ISSN
0021-9509
language
English
LU publication?
yes
additional info
The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Emergency medicine/Medicine/Surgery (013240200)
id
a46f8f93-b0dd-489c-b045-33302ab78af6 (old id 1483680)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19734832?dopt=Abstract
date added to LUP
2016-04-04 09:18:07
date last changed
2021-09-15 04:07:58
@article{a46f8f93-b0dd-489c-b045-33302ab78af6,
  abstract     = {AIM: Proximal fixation is often limiting for thoracic endovascular aortic repair (TEVAR) and the stent graft may need to cover the origin of the arch branch vessels. Chimney grafts have been proposed to preserve flow into over stented branches during urgent TEVAR. The aim of this report is to share our initial experience of this technique. METHODS: Eleven patients underwent urgent TEVAR combined with a chimney graft between January 2004 and April 2009. The indications included acute complicated type B dissection (N.=2), ruptured aneurysms of the aortic arch (1) and descending aorta (2), traumatic aortic transaction (1), aortoesophageal fistula (1) and accidental over stenting of the left carotid artery during TEVAR (4). Chimney grafts were implanted into the innominate (N.=3), left carotid (7) and left subclavian (1) arteries. Mean length of follow up was 20 months. RESULTS: All chimney grafts were successfully implanted. Two patients developed a primary proximal type I endoleak: one leak was successfully coil embolized, the other awaits treatment. One paraplegia was reversed by spinal drainage but two months later, this patient presented with a contained rupture and underwent successful conversion to open repair. No other postoperative aneurysm expansion has occurred and the chimney grafts remain patent. The only aneurysm related death occurred in a patient with an unrecognized chronic occlusion of his right carotid artery who received a left carotid chimney graft and suffered from a lethal stroke. CONCLUSIONS: Chimney grafts in the supra-aortic branches seem feasible and may facilitate urgent TEVAR in patients with an inadequate proximal neck.},
  author       = {Sugiura, K and Sonesson, Björn and Akesson, M and Björses, Katarina and Holst, Jan and Malina, Martin},
  issn         = {0021-9509},
  language     = {eng},
  number       = {4},
  pages        = {475--481},
  publisher    = {Edizioni Minerva Medica},
  series       = {Journal of Cardiovascular Surgery},
  title        = {The applicability of chimney grafts in the aortic arch.},
  url          = {http://www.ncbi.nlm.nih.gov/pubmed/19734832?dopt=Abstract},
  volume       = {50},
  year         = {2009},
}