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To report our early experience with total endovascular repair of aortic arch aneurysm using additional trans-carotidal double chimney-grafts to preserve blood flow to supraaortic arteries.
Patients and Methods
The double chimney-graft technique was performed in six male patients. Main diagnoses were ruptured aneurysm, dissecting aneurysm, pseudoaneurysm and penetrating aortic ulcer (PAU). Two patients had a type Ia endoleak after TEVAR. Three patients had a history of sternotomies. In all cases all supra-aortic vessels had to be covered with aortic stent-graft to receive sufficient landing and sealing zone. Additionally, a carotid-to-subclavian bypass was performed in three cases in order to preserve the vertebrobasilar blood supply.Chimney legs were introduced to the ascending aorta slightly deeper than thoracic stent-grafts through the cut-down exposure of the common carotid arteries.
We deployed aortic stent-grafts and self-expandable chimney-grafts simultaneously and successfully. The patient with a ruptured aneurysm died due to cardiopulmonary failure on day 19, and the others survived. We detected two “gutter” endoleaks.
The triple-barrel chimney technique to supply blood flow to the supra-aortic vessels has been performed successfully in a small number of high-risk patients. It may be used in patients where the proximal landing zone of endograft would be in zone 0 and no other option is available. The long-term follow-up remains to be evaluated with the increased number of patients treated.
- 2013 American College of Cardiology Foundation