title: Use of chimney grafts in aortic arch pathologies involving the supra-aortic branches.
abstract: OBJECTIVE
  To present a clinical experience with the use of chimney grafts in the endovascular repair of aortic arch pathologies involving the supra-aortic branches.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Vascular Surgery, St. Franziskus Hospital Münster and Clinic for Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany. bernd.gehringhoff@sfh-muenster.de
authors: Bernd
authors: B
authors: Gehringhoff
authors: Giovanni
authors: G
authors: Torsello
authors: Georgios A
authors: GA
authors: Pitoulias
authors: Martin
authors: M
authors: Austermann
authors: Konstantinos P
authors: KP
authors: Donas
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017536:Carotid Artery, Common / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents; D013348:Subclavian Artery / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex