Tolenaar Jip L, van Keulen Jasper W, Trimarchi Santi, Muhs Bart E, Moll Frans L, van Herwaarden Joost A
Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Ann Vasc Surg. 2012 Oct;26(7):1030-8. doi: 10.1016/j.avsg.2011.11.029. Epub 2012 Apr 11.
Approximately 20% to 30% of the patients are considered not eligible for standard endovascular aneurysm repair because of aortic neck morphology. Most of these patients have an aortic neck situated in the vicinity of the aortic side branches, requiring extensive open surgery. The introduction of fenestrated and branched stent grafts has made endovascular branch preservation possible, but these procedures are time-consuming and expensive. The chimney procedure offers a readily available endovascular alternative for the treatment in patients with acute aneurysms and challenging anatomy. We conducted a systematic review to evaluate the short- and long-term results of the chimney procedure.
A comprehensive literature search for studies describing the chimney procedure was performed using MEDLINE and Excerpta Medica Database. All articles were critically appraised and included, based on relevance, validity, and outcome measures. Patient characteristics, details of the surgical intervention, and short- and long-term outcomes were studied.
A total of 75 patients were included who underwent a chimney procedure for the preservation of a total of 96 branches. Used operating techniques differed considerably between all studies, with an overall technical success rate of 98.9%. Three perioperative deaths were reported, of which one patient died from intervention-related complication. The follow-up duration ranged from 2 days to 54 months. Late complications included three deaths, none of which was device or aneurysm related. Three chimney grafts occluded during follow-up, of which two required reintervention.
The chimney procedure appears as an acceptable alternative for patients in an emergency setting, although data regarding long-term follow-up are not yet available.
由于主动脉颈部形态的原因，约20%至30%的患者被认为不适合进行标准的血管内动脉瘤修复术。这些患者中的大多数主动脉颈部位于主动脉侧支附近，需要进行广泛的开放手术。开窗和分支型支架移植物的引入使血管内保留分支成为可能，但这些手术耗时且昂贵。烟囱技术为急性动脉瘤和解剖结构复杂的患者提供了一种现成的血管内治疗替代方案。我们进行了一项系统评价，以评估烟囱技术的短期和长期结果。
使用MEDLINE和医学文摘数据库对描述烟囱技术的研究进行全面的文献检索。所有文章均根据相关性、有效性和结局指标进行严格评估并纳入。研究了患者特征、手术干预细节以及短期和长期结局。
共纳入75例接受烟囱技术以保留96个分支的患者。所有研究中使用的手术技术差异很大，总体技术成功率为98.9%。报告了3例围手术期死亡，其中1例患者死于与干预相关的并发症。随访时间从2天到54个月不等。晚期并发症包括3例死亡，均与器械或动脉瘤无关。随访期间3个烟囱型移植物闭塞，其中2个需要再次干预。
尽管尚无长期随访数据，但烟囱技术似乎是紧急情况下患者可接受的替代方案。
