title: European Multicenter Registry for the Performance of the Chimney/Snorkel Technique in the Treatment of Aortic Arch Pathologic Conditions.
abstract: BACKGROUND
  To study the performance of the chimney technique in the treatment of aortic arch pathologic conditions.
  
  
  METHODS
  We retrospectively evaluated the clinical and procedural outcome data of patients undergoing endovascular treatment in the aortic arch by use of the chimney technique at four European centers between June 2002 and December 2014. The primary endpoint was technical success. The secondary endpoints were type I endoleak, 30-day mortality, stroke, primary patency of the chimney graft, and freedom from reintervention.
  
  
  RESULTS
  Ninety-five patients were included in the study. The underlying pathologic conditions were degenerative aneurysm (n = 45, 47.4%), type B aortic dissection (n = 30, 31.6%), dissecting aneurysm (n = 6, 6.5%), penetrating atherosclerotic ulcer (n = 5, 5.3%), type I endoleak after previous thoracic endovascular aortic repair (n = 6, 6.3%), and aortic embolic disease (n = 3, 3.2%). Twenty-one patients (22%) underwent arch-branch debranching before chimney graft implantation. The majority of patients were treated electively (n = 49, 51.6%). Forty-six patients (48.4%) underwent urgent placement of chimney grafts because of their symptoms (n = 25) or rupture (n = 21). Technical success was 89.5%. The 30-day mortality was 9.5% (9 patients). No aorta-related death was observed. A type Ia endoleak occurred in 10 patients (10.5%) intraoperatively, resolving spontaneously within the first 30 days in 50% of these cases. Major stroke was diagnosed in 2 patients (2%). Primary patency of the chimney grafts was 98%, and 5 patients (5.2%) required a reintervention.
  
  
  CONCLUSIONS
  The chimney technique in the aortic arch proved highly and predictably successful, with a low rate of reinterventions.
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster, Münster; Department of Vascular Surgery, St. Franziskus-Hospital Münster, Münster, Germany.
authors.forename: Michel J
authors.initials: MJ
authors.lastname: Bosiers
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster, Münster; Department of Vascular Surgery, St. Franziskus-Hospital Münster, Münster, Germany. Electronic address: konstantinos.donas@googlemail.com.
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Donas
authors.affiliation: Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mangialardi
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Münster, Münster; Department of Vascular Surgery, St. Franziskus-Hospital Münster, Münster, Germany.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Torsello
authors.affiliation: Vascular Access Unit, Vascular Surgery Division, Thorax Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Vincent
authors.initials: V
authors.lastname: Riambau
authors.affiliation: Division of Vascular Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Criado
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, New York; Department of Vascular Surgery, The Cleveland Clinic, Cleveland, Ohio.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Veith
authors.affiliation: Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ronchey
authors.affiliation: Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fazzini
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland.
authors.forename: Mario
authors.initials: M
authors.lastname: Lachat
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D000072226:Computed Tomography Angiography / Q000379:methods; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D004638:Emergency Treatment / Q000379:methods / Q000401:mortality; D057867:Endoleak / Q000503:physiopathology / Q000601:surgery; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult