Outcomes of Aortic Arch Chimney Technique in a Single Center with 226 Cases

Abstract

Introduction - To report our single-center experience with chimney technique for aortic arch diseases and the early- and mid-term outcomes in these patients. 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. Pathologies included type B aortic dissection (n = 185), aortic arch aneurysm (n = 10), descending thoracic aortic aneurysm (n = 3), aortic arch pseudoaneurysm (n = 2), descending thoracic aortic pseudoaneurysm (n = 8), penetrating aortic ulcer (n = 7), intramural hematoma (n = 7), and aortic rupture (n = 4). Results - The aortic stent-grafts were deployed in zone 0 (n = 22), zone 1 (n = 13), and zone 2 (n = 191). 22 patients in zone 0 received preliminary supra-aortic vessel debranching. A total of 230 chimney stents were deployed (innominate artery, n = 21; right common carotid artery, n = 1; left common carotid artery, n = 13; left subclavian artery, n = 195). The technical success rate was 84% (189/226) and immediate type Ia endoleak occurred in 37 (16%) patients. The 30-day mortality and morbidity was 2% (4/226) and 4% (8/226), respectively. Four major strokes, three spinal cord ischemia and one aortic rupture occurred in the early-term. The mean duration of clinical and imaging follow-up was 22 ± 16 months and 20 ± 14 months, respectively. Late type Ia endoleaks were recorded in two patients. Chimney stent occlusions were recorded in six patients and all were in left subclavian arteries. During follow-up, five patients died due to aortic rupture (n = 3), cerebral hemorrhage (n =1) or rectal cancer (n = 1). Two major strokes occurred, one of them died and the other recovered). One patient received reoperation because of the distal expansion, so the re-intervention rate was 0.5% (1/222). Conclusion - The early and mid-term outcomes from the present study demonstrate that the chimney technique for different zones aortic arch diseases is safe and feasible, but immediate type Ia endoleak should be concerned due to these patients with uncertain late outcomes.