Late Retrograde Migration of a Left Subclavian Artery Chimney Stent-Graft Into the Innominate Artery.
OBJECTIVE
To report an uncommon case of chimney stent-graft migration in the aortic arch.


METHODS
A 29-year-old man presented with chronic left arm hyposthenia after late displacement and thrombosis of a left subclavian artery (LSA) chimney graft that migrated retrogradely into the innominate artery 2 years after deployment. The self-expanding LSA chimney was placed during a redo procedure to repair a pseudoaneurysm and type I endoleak after an index emergency thoracic endovascular aortic repair for traumatic aortic rupture 1 year earlier. The patient was successfully treated in an elective procedure via a median sternotomy, with arch aortotomy under circulatory arrest to remove the proximal end of the thrombosed chimney graft from the ostium of the innominate trunk. Three months later, a left carotid-to-subclavian bypass was performed to restore flow to the left arm.


CONCLUSIONS
Migration of the proximal end of an overly long chimney graft that moved freely in the aortic arch exposed the patient to a high risk of stroke and death. Because of the high-risk situation, open repair under circulatory arrest was elected to remove the proximal end of the chimney graft, with no major complications.
Vascular Surgery Unit, San Raffaele Scientific Institute, Milan, Italy.
Marco
M
Leopardi
Vascular Surgery Unit, San Raffaele Scientific Institute, Milan, Italy.
Yamume
Y
Tshomba
Cardiac Surgery Unit, San Raffaele Scientific Institute, Milan, Italy.
Alessandro
A
Castiglioni
Vascular Surgery Unit, San Raffaele Scientific Institute, Milan, Italy.
Domenico
D
Baccellieri
Vascular Surgery Unit, San Raffaele Scientific Institute, Milan, Italy.
Andrea
A
Kahlberg
Thoracic Surgery Unit, San Raffaele Scientific Institute, Milan, Italy.
Giampiero
G
Negri
Vascular Surgery Unit, San Raffaele Scientific Institute, Milan, Italy.
Germano
G
Melissano
Vascular Surgery Unit, San Raffaele Scientific Institute, Milan, Italy.
Roberto
R
Chiesa
D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D016122:Brachiocephalic Trunk / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D000072226:Computed Tomography Angiography; D020878:Device Removal; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012039:Regional Blood Flow; D012086:Reoperation; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
aortic isthmic rupture; chimney technique; innominate artery; left subclavian artery; open surgery; stent-graft migration; thoracic endovascular aortic repair