Skip to main content

Advertisement

SpringerLink
Log in

Comparison of Chimney Technique and Single-Branched Stent Graft for Treating Patients with Type B Aortic Dissections that Involved the Left Subclavian Artery

  • Clinical Investigation
  • Arterial Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Objective

To compare the short-term efficiency of two different endovascular repairs for type B aortic dissection involving the left subclavian artery.

Methods

From February 2013 to March 2016, a cohort of 43 patients with TBADs involving the LSA underwent thoracic endovascular aortic repair (TEVAR) in two departments, consisting of 22 (Group A) with chimney grafts (CGs) and 21 (Group B) with single-branched stent graft (SBSG). Results of the two groups in perioperative and follow-up period (≥ 3 months) were comparatively analyzed, especially on aortic remodeling.

Results

Endoluminal repair of the two groups was successfully carried out. The median follow-up period was 19 months (range, 3–43 months) in Group A and 12 months in Group B (range, 6–32 months). During the TEVAR, one CG compression occurred in Group A and one type I endoleak in Group B. During follow-up, four complications occurred in Group A (two CGs occlusion, one type I endoleak and one death from dissecting aneurysm rupture), compared with two occurred in Group B (one sidearm graft twist and one death from myocardial infarction). Complete thrombosis of the false lumen (FL) in thoracic aorta was revealed in 83.3% (15/18) cases in Group A and 89.5% (17/19) in Group B. Partial thrombosis of the FL was revealed in 16.7% (3/18) cases in Group A and 10.5% (2/19) in Group B. In the abdominal aorta, complete thrombosis of the FL was noted in 23.1% (3/13) cases in Group A and 36.4% (4/11) in Group B. Partial thrombosis of the FL was revealed in 76.9% (10/13) cases in Group A and 63.6% (7/11) in Group B. Significant true lumen re-expansion and false lumen regression were observed in different levels of the descending aorta by computed tomography angiography (CTA) in both Groups A and B (P < 0.05). No significant diametric changes of abdominal aorta were found during follow-up in both groups.

Conclusions

For patients with TBADs involving the LSA, the chimney technique and the SBSG revealed comparable results. Further evaluation of more patients with longer follow-up is needed to substantiate these results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

LSA:

Left subclavian artery

TBADs:

Type B aortic dissection

TEVAR:

Thoracic endovascular aortic repair

CGs:

Chimney grafts

SBSG:

Single-branched stent graft

FL:

False lumen

TL:

True lumen

CTA:

Computed tomography angiography

CFA:

Common femoral artery

References

  1. Dake MD, Kato N, Mitchell RS, Semba CP, Razavi MK, Shimono T, et al. Endovascular stent–graft placement for the treatment of acute aortic dissection. N Engl J Med. 1999;340(20):1546–52.

    Article  CAS  PubMed  Google Scholar 

  2. Nienaber CA, Fattori R, Lund G, Dieckmann C, Wolf W, von Kodolitsch Y, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med. 1999;340(20):1539–45.

    Article  CAS  PubMed  Google Scholar 

  3. Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the international registry of acute aortic dissection. J Am Coll Cardiol. 2015;66(4):350–8.

    Article  PubMed  Google Scholar 

  4. Nienaber CA, Kische S, Rousseau H. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. J Vasc Surg. 2013;59(2):554.

    Article  Google Scholar 

  5. Hanna JM, Andersen ND, Ganapathi AM, McCann RL, Hughes GC. Five-year results for endovascular repair of acute complicated type B aortic dissection. J Vasc Surg. 2014;59(1):96–106.

    Article  PubMed  Google Scholar 

  6. Peterson BG, Eskandari MK, Gleason TG, Morasch MD. Utility of left subclavian artery revascularization in association with endoluminal repair of acute and chronic thoracic aortic pathology. J Vasc Surg. 2006;43(3):433–9.

    Article  PubMed  Google Scholar 

  7. Caronno R, Piffaretti G, Tozzi M, Lomazzi C, Rivolta N, Castelli P. Intentional coverage of the left subclavian artery during endovascular stent graft repair for thoracic aortic disease. Surg Endosc. 2006;20(6):915–8.

    Article  CAS  PubMed  Google Scholar 

  8. Waterford SD, Chou D, Bombien R, Uzun I, Shah A, Khoynezhad A. Left subclavian arterial coverage and stroke during thoracic aortic endografting: a systematic review. Ann Thorac Surg. 2015;101(1):381–9.

    Article  PubMed  Google Scholar 

  9. Zamor KC, Eskandari MK, Rodriguez HE, Ho KJ, Morasch MD, Hoel AW. Outcomes of thoracic endovascular aortic repair and subclavian revascularization techniques. J Am Coll Surg. 2015;221(1):93–100.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zhang M, Yuan Y, Hu Y, Zhao Y, Liu H, Ma B, et al. Endovascular repair with the chimney technique for Stanford type B aortic dissection involving right-sided arch with aberrant left subclavian artery. Ann Vasc Surg. 2014;28(7):1798.e7–10.

    Article  Google Scholar 

  11. Bosiers MJ, Donas KP, Mangialardi N, Torsello G, Riambau V, Criado FJ, et al. European multicenter registry for the performance of the chimney/snorkel technique in the treatment of aortic arch pathologic conditions. Ann Thorac Surg. 2016;101(6):2224–30.

    Article  PubMed  Google Scholar 

  12. Roselli EE, Arko FR 3rd, Thompson MM, Valiant Mona LSATI. Results of the Valiant Mona LSA early feasibility study for descending thoracic aneurysms. J Vasc Surg. 2015;62(6):1465–71.

    Article  PubMed  Google Scholar 

  13. Patel HJ, Dake MD, Bavaria JE, Singh MJ, Filinger M, Fischbein MP, et al. Branched endovascular therapy of the distal aortic arch: preliminary results of the feasibility multicenter trial of the gore thoracic branch endoprosthesis. Ann Thorac Surg. 2016;102:1190–8.

    Article  PubMed  Google Scholar 

  14. Huang C, Tang H, Qiao T, Liu C, Zhou M. Early results of chimney technique for type B aortic dissections extending to the aortic arch. Cardiovasc Intervent Radiol. 2016;39(1):28–35.

    Article  PubMed  Google Scholar 

  15. Feng J, Lu Q, Zhao Z, Bao J, Feng X, Qu L, et al. Restrictive bare stent for prevention of stent graft-induced distal redissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg. 2013;57(2, Supplement):44S–52S.

    Article  PubMed  Google Scholar 

  16. Huang H, Jiao Y, Zhang Y, Zhu Y, Liu Z, Qiao T, et al. Implantation of unibody single-branched stent graft for patients with type B aortic dissections involving the left subclavian artery: 1-year follow-up outcomes. Cardiovasc Intervent Radiol. 2017;40(11):1678–86.

    Article  PubMed  Google Scholar 

  17. Trimarchi S, Eagle KA. Thoracic endovascular aortic repair in acute and chronic type B aortic dissection. JACC Cardiovasc Interv. 2016;9(2):192–4.

    Article  PubMed  Google Scholar 

  18. Rizvi AZ, Murad MH, Fairman RM, Erwin PJ, Montori VM. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: a systematic review and meta-analysis. J Vasc Surg. 2009;50(5):1159–69.

    Article  PubMed  Google Scholar 

  19. Matsumura JS, Lee WA, Mitchell RS, Farber MA, Murad MH, Lumsden AB, et al. The Society for Vascular Surgery Practice Guidelines: management of the left subclavian artery with thoracic endovascular aortic repair. J Vasc Surg. 2009;50(5):1155–8.

    Article  PubMed  Google Scholar 

  20. Criado FJ. A percutaneous technique for preservation of arch branch patency during thoracic endovascular aortic repair (TEVAR): retrograde catheterization and stenting. J Endovasc Ther. 2007;14(1):54–8.

    Article  PubMed  Google Scholar 

  21. Xue Y, Sun L, Zheng J, Huang X, Guo X, Li T, et al. The chimney technique for preserving the left subclavian artery in thoracic endovascular aortic repair. Eur J Cardiothorac Surg. 2015;47(4):623–9.

    Article  PubMed  Google Scholar 

  22. Lindblad B, Bin Jabr A, Holst J, Malina M. Chimney grafts in aortic stent grafting: hazardous or useful technique? Systematic review of current data. Eur J Vasc Endovasc Surg. 2015;50(6):722–31.

    Article  CAS  PubMed  Google Scholar 

  23. Moulakakis KG, Mylonas SN, Avgerinos E, Papapetrou A, Kakisis JD, Brountzos EN, et al. The chimney graft technique for preserving visceral vessels during endovascular treatment of aortic pathologies. J Vasc Surg. 2012;55(5):1497–503.

    Article  PubMed  Google Scholar 

  24. Mangialardi N, Ronchey S, Malaj A, Fazzini S, Alberti V, Ardita V, et al. Value and limitations of chimney grafts to treat arch lesions. J Cardiovasc Surg. 2015;56(4):503–11.

    CAS  Google Scholar 

  25. Inoue K, Hosokawa H, Iwase T, Sato M, Yoshida Y, Ueno K, et al. Aortic arch reconstruction by transluminally placed endovascular branched stent graft. Circulation. 1999;100(2):II-316-Ii-21.

    Google Scholar 

  26. Huang C, Liu Z, Huang D, Qiao T, Zhou M, Liu C. Application of unibody single-branch endografts in Stanford type B dissections with primary entry tear adjacent to the left subclavian artery: a computed tomography-based planning study. Ann Vasc Surg. 2015;29(6):1174–80.

    Article  PubMed  Google Scholar 

  27. Lu Q, Feng J, Zhou J, Zhao Z, Li H, Teng Z, et al. Endovascular repair by customized branched stent-graft: a promising treatment for chronic aortic dissection involving the arch branches. J Thorac Cardiovasc Surg. 2015;150(6):1631–8.

    Article  PubMed  Google Scholar 

  28. Sueyoshi E, Sakamoto I, Hayashi K, Yamaguchi T, Imada T. Growth rate of aortic diameter in patients with type B aortic dissection during the chronic phase. Circulation. 2005;14(3):II-256-II-61.

    Google Scholar 

  29. Schoder M, Czerny M, Cejna M, Rand T, Stadler A, Sodeck GH, et al. Endovascular repair of acute type B aortic dissection: long-term follow-up of true and false lumen diameter changes. Ann Thorac Surg. 2007;83(3):1059–66.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Honggang Zhang and He Huang have contributed to this work equally and shared first authorship.

Authors and Affiliations

  1. Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, People’s Republic of China

    Honggang Zhang, He Huang, Yepeng Zhang, Zhao Liu, Tong Qiao, Changjian Liu & Min Zhou

  2. Department of Vascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China

    Xiwei Zhang & Yuanyong Jiao

  3. Department of Vascular Surgery, The First People’s Hospital of Lianyungang, Lianyungang, 222002, Jiangsu, People’s Republic of China

    Honggang Zhang & He Huang

Authors
  1. Honggang Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. He Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yepeng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhao Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tong Qiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiwei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Changjian Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yuanyong Jiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Min Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Yuanyong Jiao or Min Zhou.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, H., Huang, H., Zhang, Y. et al. Comparison of Chimney Technique and Single-Branched Stent Graft for Treating Patients with Type B Aortic Dissections that Involved the Left Subclavian Artery. Cardiovasc Intervent Radiol 42, 648–656 (2019). https://doi.org/10.1007/s00270-018-2145-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-018-2145-3

Keywords

Search

Navigation