Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece; ; The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia;
Ann Cardiothorac Surg. 2013 May;2(3):339-46. doi: 10.3978/j.issn.2225-319X.2013.05.14.
Evolution in the endovascular era has influenced the management of aortic arch pathologies. "Chimney" or "snorkel" graft technique has been used as an alternative in high risk patients unfit for open repair. We reviewed the published literature on the chimney graft technique for preservation of the supra-aortic branches in order to provide an extensive insight of its feasibility and efficacy and investigate its outcomes. 18 reports were identified, with a total of 124 patients and 136 chimney. Primary technical success was achieved in 123/124 patients (99.2%). The perioperative mortality rate was 4.8% and the stroke rate was 4%, while events of spinal cord ischemia were rare. The overall endoleak rate was 18.5%; 13 patients (10.5%) developed a type I endoleak and 10 (8%) patients a type II endoleak. During a median follow-up period of 11.4 months (range, 0.87-20.1 months) all implanted chimney grafts remained patent. From this, we conclude that endovascular aortic arch repair with chimney grafts is associated with a lower mortality rate compared to totally open or hybrid reconstruction. However, the stroke rate remains noteworthy, and requires longterm data to elucidate.
腔内时代的发展影响了主动脉弓病变的治疗策略。对于不适合开放修复的高危患者，“烟囱”或“通气管”技术已被用作一种替代方法。我们回顾了关于保留主动脉弓分支的烟囱移植技术的文献，以便更全面地了解其可行性和疗效，并研究其结果。共确定了 18 份报告，其中共有 124 名患者和 136 个烟囱。124 例患者中 123 例（99.2%）达到了主要技术成功。围手术期死亡率为 4.8%，卒中发生率为 4%，而脊髓缺血事件罕见。总的内漏发生率为 18.5%；13 名患者（10.5%）发生 1 型内漏，10 名患者（8%）发生 2 型内漏。在中位数为 11.4 个月（范围为 0.87-20.1 个月）的随访期间，所有植入的烟囱移植物均保持通畅。由此我们得出结论，与完全开放或杂交重建相比，主动脉弓腔内修复术联合烟囱技术与较低的死亡率相关。然而，卒中发生率仍值得关注，需要长期数据来阐明。
