title: Triple-barrel graft as a novel strategy to preserve supra-aortic branches in arch-TEVAR procedures: clinical study and systematic review.
abstract: OBJECTIVE
  To report our early experience with total endovascular repair of aortic-arch aneurysm using double chimney-grafts and present a literature overview.
  
  
  METHODS
  The double chimney-graft technique was performed in six male patients with contained ruptured aneurysm, dissecting aneurysm, pseudoaneurysm, penetrating aortic ulcer and proximal endoleak after TEVAR. Furthermore, a systematic electronic health database search of available articles was conducted according to PRISMA Guidelines.
  
  
  RESULTS
  In all cases, all supra-aortic vessels had to be covered with aortic stent-graft to receive a sufficient landing and sealing zone. Chimney-grafts were introduced to the ascending aorta slightly deeper than the thoracic stent-grafts through the cut-down exposure of the common carotid arteries. We deployed aortic stent-grafts and self-expandable chimney-grafts simultaneously and successfully. The patient with contained ruptured aneurysm died due to cardiopulmonary failure on day 19, the others survived. We detected two 'gutter' endoleaks. As a result of literature search, 12 articles met the inclusion criteria. Two articles described the double-chimney technique.
  
  
  CONCLUSIONS
  The use of double chimney-grafts is possible in high-risk patients where the proximal landing zone of endograft would be in zone 0. The available data is still limited. The long-term follow-up remains to be evaluated with the increased number of patients treated.
authors.affiliation: Department of Vascular Surgery, University Hospital of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany. robert.shahverdyan@uk-koeln.de
authors.forename: R
authors.initials: R
authors.lastname: Shahverdyan
authors.forename: M
authors.initials: M
authors.lastname: Gawenda
authors.forename: J
authors.initials: J
authors.lastname: Brunkwall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery; D017541:Aneurysm, False / Q000401:mortality / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014456:Ulcer / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*