First experience with the double chimney technique in the treatment of aortic arch diseases

Tun Wang; Chang Shu; Quan-Ming Li; Ming Li; Xin Li; Hao He; Alan Dardik; Jian Qiu

doi:10.1016/j.jvs.2017.02.035

First experience with the double chimney technique in the treatment of aortic arch diseases

J Vasc Surg. 2017 Oct;66(4):1018-1027. doi: 10.1016/j.jvs.2017.02.035. Epub 2017 May 11.

Authors

Tun Wang¹, Chang Shu², Quan-Ming Li¹, Ming Li¹, Xin Li¹, Hao He¹, Alan Dardik³, Jian Qiu¹

Affiliations

¹ Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China; Angiopathy Institute of Central South University, Changsha, China.
² Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China; Angiopathy Institute of Central South University, Changsha, China; Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China. Electronic address: changshu_vascular@163.com.
³ Department of Surgery, Yale University School of Medicine, New Haven, Conn.

PMID: 28502544
DOI: 10.1016/j.jvs.2017.02.035

Abstract

Objective: The objective of this study was to summarize our initial experience using the double chimney technique to treat aortic arch diseases.

Methods: From December 2009 to October 2016, 23 patients with aortic arch diseases, including 20 acute aortic dissections, 2 aortic arch aneurysms, and 1 type I endoleak after thoracic endovascular aortic repair (TEVAR), were treated using a double chimney technique. An emergent operation was performed in only one patient with an acute aortic dissection for severe left lower extremity ischemia. All patients were observed after TEVAR with computed tomography scans at 2 weeks, at 3 and 6 months, and annually thereafter.

Results: In all patients, aortic arch lesions were covered, and supra-aortic branches were patent without morbidity. In 22 patients, the innominate artery (IA) and left common carotid artery were reconstructed with the proximal landing zone in zone 0; in 1 patient, the left common carotid artery and left subclavian artery were reconstructed. During the procedure, there were three (13.0%) type I endoleaks. Chimney stent graft migration occurred in one (4.3%) patient perioperatively; compression of a chimney stent graft occurred in one (4.3%) patient 4 days after TEVAR. There were no type II endoleaks or perioperative mortality. Median follow-up was 28.0 ± 19.8 (range, 3-84) months, with no TEVAR-related deaths. Partial compression of the chimney stent graft in the IA occurred at 3 months after TEVAR in one (4.3%) patient; three patients had persistent but asymptomatic type I endoleaks.

Conclusions: TEVAR using a double chimney technique to reconstruct the supra-aortic branches provides a safe and minimally invasive alternative procedure associated with low postoperative mortality. The main perioperative complications include type I endoleak and compression of the chimney stent grafts in the IA. More experience with long-term results is needed to evaluate the effectiveness and durability of this advanced endovascular procedure.

MeSH terms

Aged
Aged, 80 and over
Angiography, Digital Subtraction
Aortic Aneurysm, Thoracic / diagnostic imaging
Aortic Aneurysm, Thoracic / surgery*
Aortic Dissection / diagnostic imaging
Aortic Dissection / surgery*
Aortography / methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation / adverse effects
Blood Vessel Prosthesis Implantation / instrumentation
Blood Vessel Prosthesis Implantation / methods*
Computed Tomography Angiography
Endoleak / diagnostic imaging
Endoleak / surgery*
Endovascular Procedures / adverse effects
Endovascular Procedures / instrumentation
Endovascular Procedures / methods*
Female
Humans
Male
Middle Aged
Postoperative Complications / etiology
Retrospective Studies
Risk Factors
Stents
Time Factors
Treatment Outcome