title: Endovascular chimney technique of aortic arch pathologies: a systematic review.
abstract: BACKGROUND
  The aim of this review was to determine the safety and efficacy of endovascular chimney technique for aortic arch pathologies by performing a systematic and pooled analysis of the relevant literature.
  
  
  METHODS
  Electronic searches were performed in database Medline between 1994 and 2011 to identify studies on endovascular chimney technique for aortic arch pathology. The extracted variables and outcomes were synthesized through pooled analyses.
  
  
  RESULTS
  Eight articles with 51 patients who underwent endovascular chimney technique for aortic arch pathologies met the inclusion criteria. Chimney grafts were deployed in innominate (n = 11), left common carotid (n = 32), and left subclavian (n = 12) arteries. Single-stent chimney in the deployed artery was used in 37 patients, whereas double-stent chimney was utilized in 14 patients. The overall technical success rate was 90.2%. The overall perioperative mortality and morbidity were 5.9% and 13.7%, respectively. The stroke rate was 7.8%, and the fatal stroke rate accounted for 50%. The rates of primary early endoleaks and type-Ia endoleaks were 21.6% and 11.8%, respectively. The overall late mortality and morbidity were 4.4% and 15.5%, respectively. Of 5 late endoleaks, no secondary type-Ia endoleak occurred. No studies had adequate follow-up to reliably evaluate the long-time durability.
  
  
  CONCLUSIONS
  Endovascular chimney technique is technically feasible with the high initial technical success rate and relatively favorable rates of perioperative outcomes for aortic arch pathologies. However, further establishment of the role of endovascular chimney necessitates the accumulation of more cases and comparative study with other management as well as prolonged follow-up.
authors.affiliation: Department of Vascular Surgery, Clinical Division of Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China.
authors.forename: Jian
authors.initials: J
authors.lastname: Yang
authors.forename: Jiang
authors.initials: J
authors.lastname: Xiong
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Liu
authors.forename: Xin
authors.initials: X
authors.lastname: Jia
authors.forename: Yating
authors.initials: Y
authors.lastname: Zhu
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome