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Outcomes of thoracic endovascular aortic repair with chimney technique for aortic arch diseases
OBJECTIVE: This study aimed to summarize the long-term experience of using the chimney technique in thoracic endovascular aortic repair (TEVAR) for aortic arch diseases. METHODS: From November 2007 to June 2021, a total of 345 consecutive patients (mean age 56 ± 11.3 years, range 28–83, 302 men) wit...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9386043/ https://www.ncbi.nlm.nih.gov/pubmed/35990957 http://dx.doi.org/10.3389/fcvm.2022.868457 |
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author | Li, Jiehua Xue, Yunfei Li, Shangqian Sun, Likun Wang, Lunchang Wang, Tun Fang, Kun Luo, Mingyao Li, Xin He, Hao Li, Ming Li, Quanming Dardik, Alan Shu, Chang |
author_facet | Li, Jiehua Xue, Yunfei Li, Shangqian Sun, Likun Wang, Lunchang Wang, Tun Fang, Kun Luo, Mingyao Li, Xin He, Hao Li, Ming Li, Quanming Dardik, Alan Shu, Chang |
author_sort | Li, Jiehua |
collection | PubMed |
description | OBJECTIVE: This study aimed to summarize the long-term experience of using the chimney technique in thoracic endovascular aortic repair (TEVAR) for aortic arch diseases. METHODS: From November 2007 to June 2021, a total of 345 consecutive patients (mean age 56 ± 11.3 years, range 28–83, 302 men) with aortic arch pathologies underwent TEVAR combined with chimney technique (cTEVAR). Their medical data and follow-up results were retrospectively reviewed and analyzed. RESULTS: Among the 345 patients, 278 (80.6%) received single chimneys, 53 (15.4%) received double chimneys, 7 (2%) received triple chimneys, and 7 (2%) underwent cTEVAR accompanied by other techniques (two with extra-anatomical bypass, two with in situ fenestration, and three with physician modified fenestration). A total of 412 chimney stents were used, including 27 in the innominate artery (IA), 113 in the left common carotid artery, 270 in the left subclavian artery, and two in the aberrant right subclavian artery. Early type IA endoleaks were found in 38 (11%) patients, including 12 with the double or triple chimney technique. Early type II endoleak was found in nine (2.6%) patients. Early re-intervention occurred in two patients with double chimney technique, one for chimney stent migration and the other for compression of chimney stent. The 30-day mortality was 1.2% (4 in 345). During a mean follow-up of 42 ± 22 months (range 1–108 months), major stroke occurred in nine (2.6%) patients, chimney occlusion or stenosis occurred in six (1.7%), and retrograde type A aortic dissection occurred in four (1.2%). Fourteen (4.1%) patients received the secondary intervention. The all-cause mortality was 6.7% (23 in 345). Additionally, the total adverse event rate after cTEVAR was 13.9% (48 in 345). CONCLUSION: TEVAR with chimney technique provides a minimally invasive alternative with good chimney graft patency and low postoperative mortality during follow-up. However, the double and triple chimney techniques should be used cautiously as they seem to have a higher risk for type IA endoleak and adverse events after the operation. |
format | Online Article Text |
id | pubmed-9386043 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-93860432022-08-19 Outcomes of thoracic endovascular aortic repair with chimney technique for aortic arch diseases Li, Jiehua Xue, Yunfei Li, Shangqian Sun, Likun Wang, Lunchang Wang, Tun Fang, Kun Luo, Mingyao Li, Xin He, Hao Li, Ming Li, Quanming Dardik, Alan Shu, Chang Front Cardiovasc Med Cardiovascular Medicine OBJECTIVE: This study aimed to summarize the long-term experience of using the chimney technique in thoracic endovascular aortic repair (TEVAR) for aortic arch diseases. METHODS: From November 2007 to June 2021, a total of 345 consecutive patients (mean age 56 ± 11.3 years, range 28–83, 302 men) with aortic arch pathologies underwent TEVAR combined with chimney technique (cTEVAR). Their medical data and follow-up results were retrospectively reviewed and analyzed. RESULTS: Among the 345 patients, 278 (80.6%) received single chimneys, 53 (15.4%) received double chimneys, 7 (2%) received triple chimneys, and 7 (2%) underwent cTEVAR accompanied by other techniques (two with extra-anatomical bypass, two with in situ fenestration, and three with physician modified fenestration). A total of 412 chimney stents were used, including 27 in the innominate artery (IA), 113 in the left common carotid artery, 270 in the left subclavian artery, and two in the aberrant right subclavian artery. Early type IA endoleaks were found in 38 (11%) patients, including 12 with the double or triple chimney technique. Early type II endoleak was found in nine (2.6%) patients. Early re-intervention occurred in two patients with double chimney technique, one for chimney stent migration and the other for compression of chimney stent. The 30-day mortality was 1.2% (4 in 345). During a mean follow-up of 42 ± 22 months (range 1–108 months), major stroke occurred in nine (2.6%) patients, chimney occlusion or stenosis occurred in six (1.7%), and retrograde type A aortic dissection occurred in four (1.2%). Fourteen (4.1%) patients received the secondary intervention. The all-cause mortality was 6.7% (23 in 345). Additionally, the total adverse event rate after cTEVAR was 13.9% (48 in 345). CONCLUSION: TEVAR with chimney technique provides a minimally invasive alternative with good chimney graft patency and low postoperative mortality during follow-up. However, the double and triple chimney techniques should be used cautiously as they seem to have a higher risk for type IA endoleak and adverse events after the operation. Frontiers Media S.A. 2022-08-04 /pmc/articles/PMC9386043/ /pubmed/35990957 http://dx.doi.org/10.3389/fcvm.2022.868457 Text en Copyright © 2022 Li, Xue, Li, Sun, Wang, Wang, Fang, Luo, Li, He, Li, Li, Dardik and Shu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Li, Jiehua Xue, Yunfei Li, Shangqian Sun, Likun Wang, Lunchang Wang, Tun Fang, Kun Luo, Mingyao Li, Xin He, Hao Li, Ming Li, Quanming Dardik, Alan Shu, Chang Outcomes of thoracic endovascular aortic repair with chimney technique for aortic arch diseases |
title | Outcomes of thoracic endovascular aortic repair with chimney technique for aortic arch diseases |
title_full | Outcomes of thoracic endovascular aortic repair with chimney technique for aortic arch diseases |
title_fullStr | Outcomes of thoracic endovascular aortic repair with chimney technique for aortic arch diseases |
title_full_unstemmed | Outcomes of thoracic endovascular aortic repair with chimney technique for aortic arch diseases |
title_short | Outcomes of thoracic endovascular aortic repair with chimney technique for aortic arch diseases |
title_sort | outcomes of thoracic endovascular aortic repair with chimney technique for aortic arch diseases |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9386043/ https://www.ncbi.nlm.nih.gov/pubmed/35990957 http://dx.doi.org/10.3389/fcvm.2022.868457 |
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