AUTHOR=Li Jiehua , Xue Yunfei , Li Shangqian , Sun Likun , Wang Lunchang , Wang Tun , Fang Kun , Luo Mingyao , Li Xin , He Hao , Li Ming , Li Quanming , Dardik Alan , Shu Chang 

TITLE=Outcomes of thoracic endovascular aortic repair with chimney technique for aortic arch diseases

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.868457

DOI=10.3389/fcvm.2022.868457

ISSN=2297-055X

ABSTRACT=Objective: To summarize the long-term experience of using chimney technique in thoracic endovascular aortic repair (TEVAR) for aortic arch diseases.
Methods: From November 2007 to June 2021, a total of 345 consecutive patients (mean age 56.0±11.3 years, range 28–83, 302 men) with aortic arch pathologies underwent TEVAR combined with chimney technique (cTEVAR). Their medical data and follow-up results were retrospectively reviewed and analyzed.
Results: Among the 345 patients, 278 (80.6%) received single chimney, 53 (15.4%) received double chimneys, 7(2%) received triple chimneys, and 7(2%) underwent cTEVAR accompanied with other techniques (2 with extra-anatomical bypass, 2 with in-situ fenestration, and 3 with physician modified fenestration). A total of 412 chimney stents were used, including 27 in innominate artery, 113 in left common carotid artery, 270 in left subclavian artery and 2 in aberrant right subclavian artery. Early type Ia endoleaks were found in 38 (11%) patients, including 12 with double or triple chimney technique. Early type II endoleak were found in 9 (2.6%) patients. Early re-intervention occurred in 2 patients with double chimney technique, one for chimney stent migration and the other for compression of chimney stent. The 30-day mortality was 1.2% (4 in 345). During a mean follow-up of 42±22 months (range 1-108 months), major stroke occurred in 9 (2.6%) patients, chimney occlusion or stenosis occurred in 6 (1.7%), and retrograde type A aortic dissection occurred in 4 (1.2%). Fourteen (4.1%) patients received secondary intervention. The all-cause mortality was 6.7% (23 in 345). And the total adverse event rate after cTEVAR was 13.9% (48 in 345).
Conclusions: TEVAR with chimney technique provides a minimally invasive alternative with good chimney graft patency and low postoperative mortality during follow-up. However, the double and triple chimney techniques should be used cautiously as they seem to have higher risk for type Ia endoleak and adverse events after operation.