title: Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies.
abstract: To summarize a single-center experience using the single/double chimney technique in association with thoracic endovascular aortic repairs (TEVAR) for aortic arch pathologies.
  
  
  
  From November 2007 to March 2016, 122 patients (mean age 50.4±12.7 years, range 29-80; 92 men) with aortic arch pathologies underwent TEVAR combined with single (n=101) or double (n=21) chimney grafts to reconstruct the supra-aortic branches: 21 innominate arteries, 114 left common carotid arteries, and 8 left subclavian arteries (LSA). Pathologies included type B aortic dissection (n=47), aortic arch dissection (n=49), retrograde type A aortic dissection (n=8), thoracic aortic aneurysm (n=7), penetrating aortic arch ulcer (n=9), and post-TEVAR type I endoleak (n=2). Follow-up examinations included computed tomography at 0.5, 3, 6, and 12 months and yearly thereafter.
  
  
  
  The aortic stent-grafts were deployed in zone 0 (n=21), zone 1 (n=93), and zone 2 (n=8). One (0.8%) of the 122 patients died at 4 days due to a perforated peptic ulcer. Type Ia endoleaks were found intraoperatively in 13 (10.7%) patients, including 3 with the double chimney technique. Type II endoleaks occurred in 6 (4.9%) patients; 3 were treated with duct occluders in the LSA. Postoperative chimney graft migration occurred in 1 (0.8%) patient with double chimneys; additional stent-grafts were deployed in both chimneys. Median follow-up was 32.3 months, during which 1 (0.8%) patient died after a stroke at 3 months. Chimney stent-graft patency was observed in the remaining 120 patients. Two (1.7%) secondary TEVARs were performed for distal aortic dissection. Nine asymptomatic type Ia endoleaks and 1 type II endoleak persisted in follow-up; a type II endoleak in 1 patient with Marfan syndrome sealed in 52 months.
  
  
  
  TEVAR with the chimney technique provides a safe, minimally invasive alternative with good chimney graft patency and low postoperative mortality during midterm follow-up. The double chimney technique should be used judiciously owing to its potential complications.
authors.affiliation: 1 Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China.|2 Angiopathy Institute, Central South University, Changsha, Hunan, China.
authors.forename: Tun
authors.initials: T
authors.lastname: Wang
authors.affiliation: 1 Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China.|2 Angiopathy Institute, Central South University, Changsha, Hunan, China.|3 Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China.
authors.forename: Chang
authors.initials: C
authors.lastname: Shu
authors.affiliation: 1 Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China.|2 Angiopathy Institute, Central South University, Changsha, Hunan, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.affiliation: 1 Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China.|2 Angiopathy Institute, Central South University, Changsha, Hunan, China.
authors.forename: Quan-Ming
authors.initials: QM
authors.lastname: Li
authors.affiliation: 1 Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China.|2 Angiopathy Institute, Central South University, Changsha, Hunan, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Li
authors.affiliation: 1 Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China.|2 Angiopathy Institute, Central South University, Changsha, Hunan, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Qiu
authors.affiliation: 3 Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Fang
authors.affiliation: 4 Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Dardik
authors.affiliation: 1 Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China.|2 Angiopathy Institute, Central South University, Changsha, Hunan, China.
authors.forename: Chen-Zi
authors.initials: CZ
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D002681:China; D000072226:Computed Tomography Angiography; D018572:Disease-Free Survival; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic arch; aortic dissection; chimney graft/technique; common carotid artery; endoleak; innominate artery; left subclavian artery; migration; mortality; stent-graft; stroke; thoracic aortic dissection; thoracic endovascular aortic repair; type I endoleak