Tianjin Medical Journal

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The Application of Chimney Technique in Thoracic Endovascular Aortic Repair of Thoracic Aortic Lesions

1,Minxin Wei 3   

  • Received:2013-09-22 Revised:2013-11-21 Published:2014-04-15 Online:2014-04-15
  • Contact: Minxin Wei

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Abstract:

 

[Abstract] Objective To evaluate the feasibility of strent-graft with Chimney technique in thoracic endovascular aortic repair (TEVAR) of thoracic aortic dissection left subclavian artery (LSA) disease and left common carotid artery (LCCA) disease without good landing zone. Methods A total of21patients with thoracic aortic diseases complicated by in? sufficient proximal anchoring area，who were presented in our hospital in recent years，were selected in this study. The clini? cal data were retrospectively analyzed. The thoracic aortic diseases included aortic dissection (n=11), aortic pseudoaneurysm (n=2), aortic aneurysm(n=1) and penetrating ulcer(n=7). Among all 21patients，lesion was located in distal to LSA in 18pa? tients with distance to LSA anchoring less than15mm,and the lesion was located between the LSA and LCCA in the rest3 patients．Thoracic aortic stent-graft placement was carried out．The ostium of LSA was intentionally and completely cov? ered by thoracic aortic stent-graft and left subclavian artery or left internal carotid artery stent-graft placement was subse? quently performed．The patients were observed for symptoms of cerebral and upper limb ischemia. The postoperative com? plications such as endoleak and the patency of LSA were assessed with angiography.Results Thoracic aortic stent-graft placement was suceessfully carried out in all21patients. In addition，one“Chimney”stent was properly implanted in LSA or LICA in each patient．After the procedure，no complications of nervous system or severe ischemia of upper extremity was observed．Follow-up examinations between to38months after the treatment revealed that the aortic stent-graft remained in stable condition without type I endoleak. Meanwhile the blood flow in“chinney”stent was unobstructed. Conclusion Chimney technique can expand the applicability of TSGP with high tolerance. Chimney technique expand the applicability of TEVAR for patients with challenging anatomy. It is a safe，effective and microinvasive method to treat thoracic aortic lesions.

Key words: Chimney technique, Aortic dissection, Left subclavian artery, Proximal anchoring area