Use of Chimney Grafts in Aortic Arch Pathologies Involving the Supra-Aortic Branches

Abstract

To present a clinical experience with the use of chimney grafts in the endovascular repair of aortic arch pathologies involving the supra-aortic branches. The chimney technique consists of endovascular stent or stent-graft placement parallel to the main aortic stent-graft in order to preserve or rescue flow to aortic branch vessels and to allow proximal extension of endograft fixation zones. Between April 2009 and January 2011, 9 patients (7 men; mean age 58 years, range 39-76) had chimney grafts installed to the left subclavian artery (LSA) or left common carotid artery (LCCA) during urgent thoracic endovascular aortic repair (TEVAR) of 5 aortic arch aneurysms, a mobile aortic thrombus with peripheral embolism, symptomatic type B dissection, penetrating aortic ulcer, and persistent type I endoleak after TEVAR. Eight chimney grafts were implanted into the LSA in 6 patients and 5 into the LCCA in the other 3 patients. The immediate technical success was 88.9%. The post-TEVAR type I endoleak persisted despite the chimney graft; the patient underwent surgical arch replacement. One patient died within 30 days due to cardiac insufficiency. There were 2 access site complications requiring surgery (brachial artery pseudoaneurysm and heavily calcified femoral artery puncture site). Over a median follow-up of 15 months (range 4-22), all chimney grafts remained patent in the 7 surviving and successfully treated patients. The use of chimney grafts in selected aortic arch pathologies with involvement of supra-aortic branches is safe and feasible. Long-term results and large series are needed in order to draw robust conclusions regarding this promising alternative endovascular technique.