Department of Vascular Surgery, St. Franziskus Hospital Münster and Clinic for Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany.
J Endovasc Ther. 2011 Oct;18(5):650-5. doi: 10.1583/11-3504.1.
To present a clinical experience with the use of chimney grafts in the endovascular repair of aortic arch pathologies involving the supra-aortic branches.
The chimney technique consists of endovascular stent or stent-graft placement parallel to the main aortic stent-graft in order to preserve or rescue flow to aortic branch vessels and to allow proximal extension of endograft fixation zones. Between April 2009 and January 2011, 9 patients (7 men; mean age 58 years, range 39-76) had chimney grafts installed to the left subclavian artery (LSA) or left common carotid artery (LCCA) during urgent thoracic endovascular aortic repair (TEVAR) of 5 aortic arch aneurysms, a mobile aortic thrombus with peripheral embolism, symptomatic type B dissection, penetrating aortic ulcer, and persistent type I endoleak after TEVAR. Eight chimney grafts were implanted into the LSA in 6 patients and 5 into the LCCA in the other 3 patients.
The immediate technical success was 88.9%. The post-TEVAR type I endoleak persisted despite the chimney graft; the patient underwent surgical arch replacement. One patient died within 30 days due to cardiac insufficiency. There were 2 access site complications requiring surgery (brachial artery pseudoaneurysm and heavily calcified femoral artery puncture site). Over a median follow-up of 15 months (range 4-22), all chimney grafts remained patent in the 7 surviving and successfully treated patients.
The use of chimney grafts in selected aortic arch pathologies with involvement of supra-aortic branches is safe and feasible. Long-term results and large series are needed in order to draw robust conclusions regarding this promising alternative endovascular technique.
介绍使用烟囱技术在主动脉弓病变的血管内修复中涉及到主动脉弓分支的临床经验。
烟囱技术包括在主主动脉支架-移植物中平行放置血管内支架或支架-移植物，以保留或挽救主动脉分支血管的血流，并允许近端延长移植物固定区。在 2009 年 4 月至 2011 年 1 月期间，9 名患者（7 名男性；平均年龄 58 岁，范围 39-76 岁）在 5 例主动脉弓动脉瘤、1 例移动性主动脉血栓伴外周栓塞、症状性 B 型夹层、穿透性主动脉溃疡和 TEVAR 后持续性 I 型内漏的紧急胸主动脉血管内修复（TEVAR）期间接受了左锁骨下动脉（LSA）或左颈总动脉（LCCA）的烟囱移植物安装。在 6 名患者中，8 个烟囱移植物植入 LSA，3 名患者中 5 个植入 LCCA。
即时技术成功率为 88.9%。尽管植入了烟囱移植物，但 TEVAR 后仍存在 I 型内漏。患者接受了手术弓替换。1 名患者在 30 天内因心脏功能不全死亡。有 2 例血管入路并发症需要手术治疗（肱动脉假性动脉瘤和严重钙化的股动脉穿刺部位）。在中位随访 15 个月（范围 4-22）中，在 7 名存活且成功治疗的患者中，所有烟囱移植物均保持通畅。
在涉及主动脉弓分支的特定主动脉弓病变中使用烟囱移植物是安全可行的。需要长期结果和大系列来得出关于这种有前途的血管内替代技术的可靠结论。
