Skip header and navigation

2 records – page 1 of 1.

Efficacy and durability of the chimney graft technique in urgent and complex thoracic endovascular aortic repair.

https://arctichealth.org/en/permalink/ahliterature263150
Source
J Vasc Surg. 2015 Apr;61(4):886-94.e1
Publication Type
Article
Date
Apr-2015
Author
Adel Bin Jabr
Bengt Lindblad
Nuno Dias
Timothy Resch
Martin Malina
Source
J Vasc Surg. 2015 Apr;61(4):886-94.e1
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Aged
Aorta, Thoracic - surgery
Aortic Diseases - diagnosis - mortality - surgery
Aortography - methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects - instrumentation - mortality
Endovascular Procedures - adverse effects - instrumentation - mortality
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Postoperative Complications - mortality - therapy
Prosthesis Design
Retrospective Studies
Risk factors
Stents
Sweden
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Abstract
This study reports the early and midterm to long-term experience of chimney grafts (CGs) in urgent endovascular repair of complex lesions in the thoracic aorta.
Twenty-nine high-risk patients (20 men) who were unfit for open repair were treated using CG technique for ruptured (n = 14) or symptomatic (n = 15) aortic lesions engaging the aortic arch itself (n = 9), the descending aorta (n = 10), or the thoracoabdominal aorta (n = 10). Twenty-two patients (76%) were treated urgently (=24 hours) and seven were semiurgent (=3 days). Of 41 chimneys used, 24 were placed in supra-aortic branches and 17 in visceral branches. Median follow-up (interquartile range) for the entire cohort was 2 years (0.6-3.8 years), 2.5 years (1-4 years) for 30-day survivors, and 3.5 years (1.9-6.4 years) for those who were still alive.
Four patients (14%) died =30 days of cerebral infarction (n = 1), visceral ischemia secondary to the initial rupture (n = 1), multiple organ failure (n = 1), or heart failure (n = 1). There were 11 late deaths (38%); however, only two deaths were related to the CG technique. The primary and secondary technical success rates were 86% (25 of 29) and 97% (28 of 29), respectively. The secondary patency rate of CGs was 98%. Seventeen (68%) of the aortic lesions shrank significantly. Three patients (10%) had primary type I endoleak and another three (10%) had secondary type I endoleak. The endoleaks were managed with Onyx (ev3 Endovascular, Inc, Plymouth, Minn) or coil embolization (n = 2), restenting (n = 1), and conversion to open repair (n = 2). One secondary endoleak is still under observation after >20 months. All primary endoleaks and one secondary endoleak originated from CGs in the brachiocephalic trunk (4 of 6 [67%]).
The midterm to long-term results of the CG technique for urgent and complex lesions of the thoracic aorta in high-risk patients are promising, with low early mortality and long durability of the CGs. More patients with longer follow-up are still needed.
PubMed ID
25616907 View in PubMed
Less detail

Outcome of visceral chimney grafts after urgent endovascular repair of complex aortic lesions.

https://arctichealth.org/en/permalink/ahliterature274258
Source
J Vasc Surg. 2016 Mar;63(3):625-33
Publication Type
Article
Date
Mar-2016
Author
Adel Bin Jabr
Bengt Lindblad
Thorarinn Kristmundsson
Nuno Dias
Timothy Resch
Martin Malina
Source
J Vasc Surg. 2016 Mar;63(3):625-33
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aorta, Abdominal - physiopathology - radiography - surgery
Aortic Aneurysm, Abdominal - diagnosis - mortality - physiopathology - surgery
Aortography - methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects - instrumentation - mortality
Cause of Death
Emergencies
Endovascular Procedures - adverse effects - instrumentation - mortality
Female
Humans
Kaplan-Meier Estimate
Male
Postoperative Complications - mortality - therapy
Prosthesis Design
Retreatment
Retrospective Studies
Risk factors
Stents
Sweden
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Vascular Patency
Abstract
Endovascular abdominal aortic repair requires an adequate sealing zone. The chimney graft (CG) technique may be the only option for urgent high-risk patients who are unfit for open repair and have no adequate sealing zone. This single-center experience provides long-term results of CGs with endovascular repair for urgent and complex aortic lesions.
Between July 2006 and October 2012, 51 patients (16 women) with a median age of 77 years (interquartile range, 72-81 years), were treated urgently (within 24 hours [61%]) or semiurgently (within 3 days [39%]) with endovascular aortic repair and visceral CGs (n = 73). Median follow-up was 2.3 years (interquartile range, 0.8-5.0 years) for the whole cohort, 3 years for 30-day survivors, and 4.8 years for patients who are still alive.
Five patients (10%) died within 30 days. All of them had a sacrificed kidney. All-cause mortality was 57% (n = 29), but the chimney- and procedure-related mortality was 6% (n = 3) and 16% (n = 8), respectively. Chimney-related death was due to bleeding, infection, renal failure, and multiple organ failure. There were two postoperative ruptures; both were fatal although not related to the treated disease. The primary and secondary long-term CG patencies were 89% (65 of 73) and 93% (68 of 73), respectively. Primary type I endoleak (EL-I) occurred in 10% (5 of 51) of the patients, and only one patient had recurrent EL-I (2%; 1 of 51). No secondary endoleak was observed. Chimney-related reintervention was required in 16% (8 of 51) of the patients because of EL-I (n = 3), visceral ischemia (n = 4), and bleeding (n = 2). The reinterventions included stenting (n = 5), embolization (n = 3), and laparotomy (n = 2). Thirty-one visceral branches were sacrificed (9 celiac trunks, 9 right, and 13 left renal arteries). Among the 30-day survivors, 8 of 17 patients (47%) with a sacrificed kidney required permanent dialysis; of these, seven underwent an urgent index operation. The aneurysm sac shrank in 63% (29 of 46) of cases.
The 6% chimney-related mortality and 93% long-term patency seem promising in urgent, complex aortic lesions of a high-risk population and may justify a continued yet restrictive applicability of this technique. Most endoleaks could be sealed endovascularly. However, sacrifice of a kidney in this elderly cohort was associated with permanent dialysis in 47% of patients.
PubMed ID
26527423 View in PubMed
Less detail