Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

The Modified Chimney Technique With a Thoracic Aortic Stent Graft to Preserve the Blood Flow of the Left Common Carotid Artery for Treating Descending Thoracic Aortic Aneurysm and Dissection

  • Lee, Kyung-Nam (Department of Cardiology, Pusan National University College of Medicine) ;
  • Lee, Han-Cheol (Department of Cardiology, Pusan National University College of Medicine) ;
  • Park, Jin-Sup (Department of Cardiology, Pusan National University College of Medicine) ;
  • Kim, Bo-Won (Department of Cardiology, Pusan National University College of Medicine) ;
  • Cha, Kwang-Soo (Department of Cardiology, Pusan National University College of Medicine) ;
  • Kim, Sang-Pil (Department of Thoracic and Cardiovascular Surgery, Pusan National University College of Medicine) ;
  • Lee, Chung-Won (Department of Thoracic and Cardiovascular Surgery, Pusan National University College of Medicine) ;
  • Kim, Hae-Kyu (Department of Anesthesia, Pusan National University College of Medicine)
  • Published : 2012.05.31
⟨ Previous Next ⟩

Abstract

While thoracic endovascular aortic repair is an effective treatment option for descending thoracic aorta pathology, it does have limitations. The main limitation is related to the anatomical difficulties when disease involves the aortic arch. A fenestrated, branched aortic stent graft and hybrid operation has been introduced to overcome this limitation, but it is a custom-made device and is time consuming to manufacture. Furthermore, these devices cannot be used in an emergency setting. We report two patients with massive descending thoracic aortic aneurysm and ruptured aortic dissection very near the aortic arch who underwent a procedure which we named the modified chimney technique. The modified chimney technique can be used as a treatment option in such an emergency situation or as a rescue procedure when aortic pathology is involved near the supra-aortic vessels.

Keywords

References

  1. Cheng D, Martin J, Shennib H, et al. Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease a systematic review and meta-analysis of comparative studies. J Am Coll Cardiol 2010;55:986-1001. https://doi.org/10.1016/j.jacc.2009.11.047
  2. Malina M, Resch T, Sonesson B. EVAR and complex anatomy: an update on fenestrated and branched stent grafts. Scand J Surg 2008; 97:195-204. https://doi.org/10.1177/145749690809700226
  3. Chuter TA, Schneider DB. Endovascular repair of the aortic arch. Perspect Vasc Surg Endovasc Ther 2007;19:188-92. https://doi.org/10.1177/1531003507304165
  4. Sonesson B, Resch T, Allers M, Malina M. Endovascular total aortic arch replacement by in situ stent graft fenestration technique. J Vasc Surg 2009;49:1589-91. https://doi.org/10.1016/j.jvs.2009.02.007
  5. Criado FJ. Chimney grafts and bare stents: aortic branch preservation revisited. J Endovasc Ther 2007;14:823-4. https://doi.org/10.1583/07-2247.1
  6. Greenberg RK, Clair D, Srivastava S, et al. Should patients with challenging anatomy be offered endovascular aneurysm repair? J Vasc Surg 2003;38:990-6. https://doi.org/10.1016/S0741-5214(03)00896-6
  7. Allaqaband S, Jan MF, Bajwa T. "The chimney graft"-a simple technique for endovascular repair of complex juxtarenal abdominal aortic aneurysms in no-option patients. Catheter Cardiovasc Interv 2010;75: 1111-5.
  8. Ohrlander T, Sonesson B, Ivancev K, Resch T, Dias N, Malina M. The chimney graft: a technique for preserving or rescuing aortic branch vessels in stent-graft sealing zones. J Endovasc Ther 2008;15:427-32. https://doi.org/10.1583/07-2315.1
  9. Feezor RJ, Martin TD, Hess PJ, et al. Risk factors for perioperative stroke during thoracic endovascular aortic repairs (TEVAR). J Endovasc Ther 2007;14:568-73. https://doi.org/10.1583/1545-1550(2007)14[568:RFFPSD]2.0.CO;2
  10. Rizvi AZ, Murad MH, Fairman RM, Erwin PJ, Montori VM. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: a systematic review and meta-analysis. J Vasc Surg 2009;50:1159-69. https://doi.org/10.1016/j.jvs.2009.09.002
  11. Larzon T, Gruber G, Friberg O, Geijer H, Norgren L. Experiences of intentional carotid stenting in endovascular repair of aortic arch aneurysms: two case reports. Eur J Vasc Endovasc Surg 2005;30:147-51. https://doi.org/10.1016/j.ejvs.2005.02.049

Cited by

  1. Endovascular repair of an aortic arch pseudoaneurysm with double chimney stent grafts: a case report vol.8, pp.None, 2012, https://doi.org/10.1186/1749-8090-8-80