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@#Objective To investigate the effect of in vitro fenestration on reconstruction of left subclavian artery in endovascular treatment of aortic dissection. Methods A total of 89 patients with aortic dissection involving left subclavian artery were treated by endovascular treatment in the Second Affiliated Hospital of Fujian Medical University from February 2017 to January 2020. There were 44 patients in the test group, including 36 males and 8 females, with an average age of 58.02±13.58 years. There were 45 patients in the control group, including 35 males and 10 females, with an average age of 54.10±12.32 years. The left subclavian artery was reconstructed by in vitro fenestration in the test group and by chimney technique in the control group. The clinical data were compared between the two groups. Results The operation time of the test group was longer than that of the control group (126.16±7.53 min vs. 96.49±6.52 min, P<0.01). The median follow-up time was 31 (13-48) months. The incidence of endoleak in the test group (4.7%) was lower than that in the control group (18.6%, P=0.04) during the follow-up. There was no statistical difference in the incidence of stroke, myocardial infarction, false lumen thrombosis, retrograde aortic dissection or left subclavian artery occlusion between the two groups (P>0.05). Conclusion In vitro fenestration for reconstructing left subclavian artery in thoracic endovascular aortic repair of aortic dissection is safe and feasible, which is worthy of further clinical promotion.
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Objective:To investigate the effect of chimney stent for reconstruction of left subclavical artery (LSA) in thoracic endovascular aotic repair (TEVAR) for acute Stanford type B aortic dissection with insufficient anchorage zone and non-thrombotic false lumen.Methods:TEVAR with chimney stent for LSA in 39 cases of acute Stanford type B aortic dissection with insufficient anchorage zone and non-thrombotic false lumen was done from Feb 2013 to Jan 2021.Results:Covered chimney stents was used in 11 cases and bare chimney stents in 28 cases. There was no postoperative stroke, left upper limb ischemia, paraplegia, hemiplegia and death. No stent migration, reverse tear and dissection rupture were observed. One bare stent was obstructed after 18 months, and all the remaining stents were patent during follow-up. The rate of immediate type Ⅰa endoleak in covered chimney stent group and bare chimney stent group were 0(0/11) and 32.1%(9/28) respectively ( P=0.04). The distance from proximal tear to LSA in covered chimney stent group, endoleak subgroup and non-endoleak subgroup in bare chimney stent were (5.1±2.3)mm, (14.4±5.2)mm and (7.8±7.0)mm respectively ( P<0.05). False lumen thrombosis was formed in endoleak subgroup 2-8 weeks after operation, and endoleak disappeared. Conclusions:There is a correlation between immediate type Ⅰa endoleak in bare chimney stent for LSA and the distance from proximal tear to LSA, covered chimney stent can reduce the incidence of immediate type Ⅰa endoleak in TEVAR for acute Stanford type B aortic dissection with insufficient anchorage zone and non-thrombotic false lumen.
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Objective:To investigate the effect of different ways of reconstruction of left subclavian artery (LSA) in the treatment of complex aortic arch lesions.Methods:The clinical data of 34 patients with complex thoracic aortic disease undergoing intracavitary LSA reconstruction in our center from January 2019 to February 2020 were retrospectively analyzed. The distance of proximal healthy landing zone of all patients, including 29 aortic dissections involving LSA, 3 penetrating aortic ulcer and 2 thoracic aortic aneurysms, was less than 15 mm. Among them, 16 cases were treated with chimney technique, 16 cases were implanted with single branched stent-graft, 2 cases were received with left common carotid artery and LSA in situ fenestration.Results:The operation success rate of all 34 patients was 100%. One case was changed from in situ fenestration to chimney stenting. Followed up for 1-12 months, there were no death, cerebral ischemia, paraplegia and other postoperative complications. CTA review showed that the main and branch stents were in good shape, the patency rate of LSA branch stents was 100% and no endoleak occurred at 1 and 3 months after operation. The muscle strength and arterial blood pressure of bilateral upper limbs of all patients were basically the same.Conclusion:There is no consensus for the treatment of complex aortic arch lesions, so we need to customize the personalized plan and select the appropriate LSA reconstruction method in order to reduce the incidence of complications.
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Blunt traumatic thoracic aortic injury (BTAI) is an extremely serious medical condition with a high rate of associated mortality. Recent advances in techniques such as thoracic endovascular repair offer new opportunities to manage the critical BTAI patients in an efficacious yet less invasive manner. A 65 year-old-male suffered from multiple injuries after a fall, including BTAI in the aortic arch, which resulted in dissection of the descending thoracic-abdominal aorta and iliac artery, development of an intimal flap in the left common carotid artery, and dissection of the left subclavian artery. Based on the imaging information of this patient and our clinical experience, the combined treatment of fenestrated thoracic endovascular repair and a chimney technique was immediately planned to fully repair these dissections and moreover prevent further dissection of the branching vessels, additionally to ensure sufficient blood flow in the left subclavian artery and left common carotid artery. The intervention yielded satisfactory early outcomes. Follow-up assessment at six months reported no symptoms or complications associated with the stent-graft. Computed tomography angiography further confirmed adequate stent-graft coverage of the aortic injury.
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@#Objective To investigate the clinical effect of in situ fenestration combined with chimney technique in the treatment of aortic dissection involving left common carotid artery. Methods From January 2012 to June 2019, 53 patients with aortic dissection involving left common carotid artery were selected. There were 21 patients in the test group, including 14 males and 7 females, with an average age of 57.2±11.2 years; there were 32 patients in the control group, including 20 males and 12 females, with an average age of 56.7±12.1 years. In the test group, the left subclavian branch was reconstructed by in situ fenestration and the left common carotid artery was reconstructed by chimney technique. In the control group, the left common carotid artery was reconstructed by hybrid operation. The clinical data of the patients were compared. Results The operation time of the test group was significantly longer than that of the control group (151.8±35.2 min vs. 101.3±29.6 min, P=0.00). The patients in the two groups were followed up for 6-20 months. There was no significant difference in the incidence of pulmonary infection, stroke, steal blood syndrome, false lumen thrombosis or internal leakage between the two groups (P>0.05). The diameters of the distal and proximal ends of the true cavity in the test group increased significantly compared with those in the control group (P<0.05). Conclusion In situ fenestration combined with chimney technique is an effective method for the treatment of aortic dissection involving left common carotid artery, which is worthy of further clinical promotion.
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Objective To evaluate the mid-and long-term results of chimney-endovascular aneurysm repair (Ch-EVAR) on efficacy and durability.Methods Data of abdominal aortic aneurysm (AAA) patients receiving Ch-EVAR were retrospectively collected and analyzed.Results From Jan 2011 to Dec 2016,21 patients received Ch-EVAR in our institution including 18 males and 3 females with the average age 74.0 ±6.31 years.One patient died and 20 patients were followed up for an mean period of 53.2 months.During EVAR procedures 14 patients received left renal artery chimney stents,6 patients had right renal artery chimney stents and one did bilateral renal artery chimney stents.Technical success was achieved in all patients (100％).Differences between preoperative and one-week postoperative value of serum creatinine (P =0.639) and estimated glomerular filtration rate (eGFR) (P =0.804) showed no statistical difference.The differences of maximum sac diameter between preoperiation (60.1 ± 13.1 mm) and follow-up (59.2 ± 13.5 mm) was not significant (P =0.826).Six patients died during follow-up and none was aortic events related.All chimney stents were patent.One patient developed late type Ⅱ endoleak and refused reintervention regardless of aneurysm expansion.Conclusion For short hostile neck AAA patients with considerable surgical risk Ch-EVAR may be an effective and durable alternative.
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We presented a challenging case of a patient diagnosed with abdominal aortic aneurysm (AAA), peripheral artery disease, and chronic mesenteric ischemia (CMI). Herein, we describe the treatment in this high-risk patient diagnosed with CMI who also had critical limb ischemia and his AAA had rapidly expanded. First we performed angioplasty and celiac arterial stenting. Afterwards, we proceeded to perform balloon angioplasty of the iliac arteries and chimney endovascular aneurysm repair (Ch-EVAR) preserving the inferior mesenteric artery (IMA). The patient was discharged three days later and his IMA remained patent eighteen months post-operation. A thorough pre-operative assessment is essential in such challenging cases. Minimally invasive procedures like endovascular therapy and the chimney technique extend the prognoses in high-risk patients.
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Humans , Aneurysm , Angioplasty , Angioplasty, Balloon , Aortic Aneurysm, Abdominal , Extremities , Iliac Artery , Ischemia , Mesenteric Artery, Inferior , Mesenteric Ischemia , Peripheral Arterial Disease , Prognosis , StentsABSTRACT
Objective To observe the clinical effects of chimney technique combined with thoracic endovascular aortic repair(TEVAR) in the treatment of type B aortic dissection.Methods The clinical datas of 56 patients with type B aortic dissection in our hospital were analyzed retrospectively.According to the surgical intervention method,they were divided into observation group (22 cases,TEVAR + chimney technique) and control group (34 cases,TEVAR alone).Surgery related indicators,incidence of postoperative short-term complications and mortality between the two groups were compared.Results The success rates in both groups were 100％,and the surgical time in observation group was longer than that in control group (P ＜ 0.05).There were no significant differences in blood loss,eating time,off-bed time and hospitalization time between the two groups(P ＞ 0.05).The incidence of complications of observation group and control group within 2 weeks after operation were 18.2％ and 5.8 ％ respectively,the difference was not significant(P ＞ 0.05),as well as mortality and incidence of longterm complications during the followed period (P ＞ 0.05).Conclusion The perioperative indexes of single endovascular repair and its combination with chimney technique for the treatment of type B aortic dissection are similar.Chimney technique can reconstruct important branch flows,especially for patients with insufficiency of landing zone.However,particular attention needs to be paid to postoperative complications to avoid negative effect on the prognosis of patients.
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Objective: To investigate thoracic endovascular aortic repair (TEVAR) and “Chimney” technique for treating the involved left common carotid artery (LCCA) or left subclavian artery (LSA) in Standford B patients with aortic lesion and in-sufficient proximal anchoring area. Meanwhile, to explore the relationship between endoleaking condition and the location of lesion with the prognosis. Methods: A total of 32 relevant patients treated by TEVAR + “Chimney” technique in our hospital from 2011-09 to 2015-07 were retrospectively analyzed. Immediate post-operative image development of LCCA or LSA was observed; cerebral complications, severe upper limb ischemic symptoms and endoleaking conditions were recorded. The patients were followed-up for (3-46) months. Results: Thoracic aortic stent-graft placement was successfully carried out in all 32 patients. Immediate post-operative image development of LCCAor LSAwas favorable, no cerebral complications and no severe upper limb ischemic symptoms were observed. There were 7 patients suffered from endoleak at aortic arch including 6 with the lesion located at the greater curvature side and 1 at the small curvature side. During follow-up period, aortic stent-graft remained in a stable condition and the blood flow in “Chimney” stent was unobstructed. Endoleking condition was gradually reduced and disappeared in 5 patients, it was persisted in 2 patients. Conclusion: “Chimney” technique may prolong anchoring area and keep LCCA or LSA unobstructed, therefore expand the indication of TEVAR in a mini-invasive, safe and effective way. When aortic lesion located at the greater curvature side, the endoleaking probability could be increased.
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Objective To evaluate the feasibility of endovascular repair for retrograde type A aortic dissection.Method 35 patients of retrograde type A aortic dissection admitted to Peking University People's Hospital from December 2001 to March 2014 were treated with endovascular repair.There were 33 males and 2 females with mean age of 46 ± 9 years.29 were on acute stage,2 on subacute stage and 4 on chronic stage.The entry tear was in the descending thoracic aorta in 32 cases,between the left subclavian artery and the left common carotid artery in one,and between the left common carotid artery and the innominate artery in two.Results Entry closure was achieved in all patients with a covered stent.2 patients died in 30 days postoperatively (5.7％).1 patient with two chimney developed acute renal artery embolized which was infused by false lumin (2.9％).One patient developed transient paraparesis after graft deployment(2.9％).During the follow-up period,the aortic remodeling is perfect,no entry tear was noted in the ascending thoracic aorta.All the endografts for preserving supra-aortic branches were patent.Conclusions The endovascular repair for retrograde type A aortic dissection is feasible and effective.
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Objective To discuss the application of bare-stent“chimney”technique in treating aortic dissection associated with left common carotid rupture, and to evaluate its therapeutic effect. Methods The clinical data of 7 patients with aortic dissection accompanied with left common carotid rupture, who were admitted to Qinghai Provincial People’s Hospital during the period from February 2012 to March 2014 to receive endovascular isolation operation treatment with bare-stent “chimney” technique, were retrospectively analyzed. When the rupture of aortic dissection was occluded with covered-stent, the left common carotid rupture was isolated with “chimney”bare-stent to reconstruct the blood flow of left common carotid artery. CT angiography was performed 2 weeks after the operation to check if there was any complication such as endoleak, stent migration, etc. Results The technical success rate of endovascular isolation operation was 100%. No type I endoleak occurred. The patients were followed up for 1-13 months, the covered stent in the aorta was in good position, and the “chimney” bare-stent in the left common carotid artery was patent. No complications such as endoleak, stent migration, etc. occurred. Conclusion Bare-stent“chimney”technology can provide treatment opportunity for the patients suffering from left common carotid artery rupture accompanied by aortic dissection; the rupture can be completely obstructed and the blood flow can be reconstructed. The short-term effect is satisfactory, although the long-term effect needs to be further studied.
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A 73-year-old woman suffered from ruptured aortic arch aneurysm into mediastinum. The patient was treated by thoracic endovascular aortic repair with the double-chimney graft technique. Three days later, computed tomography (CT) revealed type 1a endoleak (EL) between the chimney grafts. Ten days later, the patient was treated by coil embolization of the aneurysm from the left subclavian artery. The patient recovered, and was without aortic aneurysm events during six months of follow up.
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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 of 21 patients 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 21 patients,lesion was located in distal to LSA in 18 pa-tients with distance to LSA anchoring less than15 mm,and the lesion was located between the LSA and LCCA in the rest 3 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 all 21 patients. 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 to 38 months 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.
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A 42-year-old man was involved in a motor vehicle collision. Imaging studies revealed the presence of a post-traumatic aortic pseudo-aneurysm (about 34x26 cm) arising from the descending thoracic aorta at the level of the left subclavian artery (LSA), prone to rupture. Thoracic endovascular aneurysm repair (TEVAR) was the only feasible option due to his poor overall medical status. In this case, LSA needed to be covered in order to extend the proximal landing zone. Eventually, modified TEVAR was successfully performed by means of the chimney technique to preserve flow to the LSA and to prevent flow into the pseudoaneurysmal sac.