P5609Outcomes of chimney technique for aortic arch diseases: a single-center experience with 226 cases

Abstract

Abstract Objective The aim of the present study is 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/descending thoracic aortic aneurysm (n=13), aortic arch pseudoaneurysm (n=10), 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). 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. In the early-term, four patients died, of which from aortic rupture (n=1), ventricular fibrillation (n=1) or major stroke (n=2). Four major strokes occurred (two patients died and two recovered), but no reintervention was recorded. Spinal cord ischemia developed in three patients. The mean duration of follow-up was 22±16 months. Late type Ia endoleaks were recorded in two patients. Chimney stent occlusions were recorded in six patients. During follow-up, five patients died, of which from aortic rupture (n=3), cerebral hemorrhage (n=1) or rectal cancer (n=1). Two major strokes occurred (one patient died and one recovered) and reintervention performed in one case. Conclusion The chimney technique for aortic arch diseases is safe and feasible. And long-term follow-up observation is needed.