抄録
Thoracic endovascular aortic repair (TEVAR) is often done by proximal fixation, and the aortic stent graft may need to be extended beyond the origin of the aortic branches. Until recently, TEVAR has been limited to aneurysms not involving critical aortic branches due to the complex nature of designing a repair that would preserve important end-organ flow. We describe the chimney graft technique, which is an alternative to the fenestrated stent-graft and has been proposed to preserve flow into the branches during TEVAR. The indications included acute complicated type B dissection, ruptured aneurysms of the aortic arch, traumatic aortic transection, aortoesophageal fistula, and accidental over stenting of the left carotid artery during TEVAR. Chimney grafts were implanted into the innominate, left carotid, and left subclavian arteries. Use of a chimney graft makes it possible to use standard off-the-shelf stent-grafts to instantly treat lesions with inadequate fixation zones, providing an alternative to fenestrated stent-grafts in urgent cases. Our initial experience with this technique suggests that it is feasible in the aortic branches and may facilitate TEVAR in patients with an inadequate proximal fixation zone.
