1078-5884/$ e see front matter 2012 European So http://dx.doi.org/10.1016/j.ejvs.2012.08.006 The concept of the chimney graft (CG) was first introduced by Greenberg et al1 with the use of renal stents to depress the proximal edge of stent graft fabric that protruded a few millimetres above the renal artery ostium. The CG involves concurrent deployment of a standard aortic endograft and covered stents into the visceral arteries such that the proximal portion of the visceral stent lies parallel to the aortic stent with the distal portion preserving flow to the overstented visceral vessel. Indications for this technique include restoration of flow in aortic branches accidentally or intentionally covered during endovascular aneurysm repair (EVAR) when the aneurysm neck is too short to provide adequate seal, and the SG needs to be placed across the aortic branches. This is particularly true in urgent cases when it is not possible to delay for the manufacture of a branched/fenestrated graft, which otherwise would be indicated, such as symptomatic or ruptured abdominal aortic aneurysms. It is also significantly cheaper than branched/fenestrated endografts. Evidence surrounding the use of CG consists of case reports and small case series only and the long-term durability of the CG remains unclear. Intuitively they have design flaws compared to branched/fenestrated grafts. The contact of the endograft to the vessel wall may be decreased by the visceral grafts; subsequently there is a poorer graft/wall interface and therefore a reduction in the radial sealing force. “Gutters” between the vessel wall, the stents, and the endografts may be difficult to seal and lead to subsequent endoleaks. The mechanism of seal around the CG stents and gutters is likely to be multifactorial.
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