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. 2019 Oct 25:14:1829-1840.
doi: 10.2147/CIA.S222948. eCollection 2019.

Outcomes Of Chimney Technique For Aortic Arch Diseases: A Single-Center Experience With 226 Cases

Wenhui Huang #  1   2 , Huanyu Ding #  2 , Minchun Jiang #  3 , Yuan Liu  2 , Cheng Huang  2 , Xinyue Yang  2   4   5 , Ruixin Fan  6 , Jianfang Luo  2   4   5 , Zhisheng Jiang  1
Affiliations

Outcomes Of Chimney Technique For Aortic Arch Diseases: A Single-Center Experience With 226 Cases

Wenhui Huang et al. Clin Interv Aging. .

Abstract

Purpose: The goal of present study is to document our single-center experience with chimney technique for aortic arch diseases.

Patients and methods: From August 2012 to October 2017, 226 patients (mean age 54±12 years; 197 men) with aortic arch diseases underwent thoracic endovascular aortic repair combined with chimney stents. The aortic stent-grafts were deployed in zone 0 (n=22), zone 1 (n=13), or zone 2 (n=191).

Results: The technical success rate was 84% (189/226) and immediate type Ia endoleak (ELIa) happened in 37 (16%) patients. The 30-day mortality and morbidity rates were 2% (4/226) and 4% (8/226), respectively. Major adverse events include four major strokes, three spinal cord ischemia and one aortic rupture in the early-term. The clinical and imaging follow-up rates were 98% (218/222) and 78% (173/222), respectively. The average lengths of clinical and imaging follow-up were 22±16 months and 20±15 months, respectively. Chimney stent obstructions in left subclavian arteries were recorded in six (3%) patients. During follow-up, five patients died (2%) and two major strokes occurred (1%). One patient (0.5%) underwent reintervention.

Conclusion: The current study documented that the chimney technique is effective and safe for treating aortic arch diseases in different aortic zones. Cautions are needed to assess the permanency of chimney stent and to reduce the immediate ELIa rate.

Keywords: aortic arch disease; chimney; endoleak; thoracic endovascular aortic repair.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Chimney stent was deployed as a bailout to reconstruct the LCCA. TBAD was confirmed by preoperative CTA (A). The aortic stent-graft was planned to deploy between LCCA and LSA (yellow arrow) (B), but the ostia of LCCA was partially covered (blue arrow) accidentally (C). Double chimney technique (LCCA + LSA) was conducted (D), and postoperative CTA showed that both chimney stents were patent without endoleak at 6 months follow-up (E and F). Abbreviations: CTA, computed tomography angiography; LCCA, left common carotid artery; LSA, left subclavian artery; TBAD, type B aortic dissection.
Figure 2
Figure 2
Kaplan–Meier curves among patients with zone 0, zone 1 and zone 2 aortic arch diseases. Cumulative all-cause death curves (A), aorta-specific death curves (B) and major adverse event curves (C) in patients with zone 0, zone 1 and zone 2 aortic arch diseases. The number of patients at risk at each year was listed in the bottom of the figure.
Figure 3
Figure 3
Kaplan–Meier curves among patients with immediate type Ia endoleak and non-immediate type Ia endoleak. Cumulative all-cause death curves (A), aorta-specific death curves (B) and major adverse event curves (C) in patients with immediate type Ia endoleak and non-immediate type Ia endoleak. The number of patients at risk at each year was listed in the bottom of the figure.
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