Universität zu Köln

Shahverdyan, Robert, Mylonas, Spyridon, Gawenda, Michael and Brunkwall, Jan ORCID: 0000-0003-3082-6009 (2018). Single-center mid-term experience with chimney-graft technique for the preservation of flow to the supra-aortic branches. Vascular, 26 (2). S. 175 - 183. LONDON: SAGE PUBLICATIONS LTD. ISSN 1708-539X

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Abstract

Objectives To investigate the feasibility and the mid-term outcomes of the chimney-graft technique for the revascularization of supra-aortic branches in patients with thoracic aortic pathologies involving the aortic arch. Methods A retrospective analysis of a prospectively maintained database between January 2010 and July 2016 was performed. Primary endpoints were 30-day and overall mortality. Secondary endpoints were technical success, target vessel patency, stroke/transitory ischemic attack and type I/III endoleak rate. Results A total of 30 patients (80% male, median age 70.0 years) were treated using the chimney-graft technique for the supra-aortic branches. The indication was a degenerative aneurysm in nine patients (32%) and a type B Stanford aortic dissection and a penetrating aortic ulcer in the descending aorta in seven patients (23%), respectively. In six patients (20.0%), the indication was an type Ia endoleak after previous endovascular thoracic repair, whereas a pseudoaneurysm after previous open repair of the descending aorta was the indication in one patient (3%). Twenty-three patients (77%) were treated electively, five (17%) emergently and two (7%) urgently because of free rupture. Technical success was achieved in 90% of patients. The 30-day/in-hospital mortality was 17% (5/30). A retrograde dissection was presented in five patients. Four patients experienced a cerebrovascular event. Eight patients had type Ia endoleak and 10 had type II. During the median follow-up of 16 months (range: 0-56), four further patients died: one in respiratory insufficiency, one due to a ruptured abdominal aortic aneurysm, one in meningitis and the last one for unknown reason. The chimney-graft patency was 100%. According to the Kaplan-Meier curve, the estimated survival at one year was 669%. Conclusions The chimney-graft technique, despite a technically demanding strategy, is a useful tool as bailout procedure in our armamentarium for high-risk patients, unsuitable for open or hybrid repair.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Shahverdyan, Robert UNSPECIFIED UNSPECIFIED UNSPECIFIED Mylonas, Spyridon UNSPECIFIED UNSPECIFIED UNSPECIFIED Gawenda, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Brunkwall, Jan UNSPECIFIED orcid.org/0000-0003-3082-6009 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-191333
DOI:	10.1177/1708538117723200
Journal or Publication Title:	Vascular
Volume:	26
Number:	2
Page Range:	S. 175 - 183
Date:	2018
Publisher:	SAGE PUBLICATIONS LTD
Place of Publication:	LONDON
ISSN:	1708-539X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ENDOVASCULAR AORTIC REPAIR; TRIPLE-BARREL GRAFT; REPORTING STANDARDS; ASCENDING AORTA; ANEURYSM REPAIR; ARCH ANEURYSMS; ZONE 0; DISSECTION; TEVAR; ENDOGRAFT Multiple languages Peripheral Vascular Disease Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/19133