Limits...
The modified chimney technique with a thoracic aortic stent graft to preserve the blood flow of the left common carotid artery for treating descending thoracic aortic aneurysm and dissection.

Lee KN, Lee HC, Park JS, Kim BW, Cha KS, Kim SP, Lee CW, Kim HK - Korean Circ J (2012)

Bottom Line: The main limitation is related to the anatomical difficulties when disease involves the aortic arch.A fenestrated, branched aortic stent graft and hybrid operation has been introduced to overcome this limitation, but it is a custom-made device and is time consuming to manufacture.Furthermore, these devices cannot be used in an emergency setting.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Pusan National University College of Medicine, Busan, Korea.

ABSTRACT
While thoracic endovascular aortic repair is an effective treatment option for descending thoracic aorta pathology, it does have limitations. The main limitation is related to the anatomical difficulties when disease involves the aortic arch. A fenestrated, branched aortic stent graft and hybrid operation has been introduced to overcome this limitation, but it is a custom-made device and is time consuming to manufacture. Furthermore, these devices cannot be used in an emergency setting. We report two patients with massive descending thoracic aortic aneurysm and ruptured aortic dissection very near the aortic arch who underwent a procedure which we named the modified chimney technique. The modified chimney technique can be used as a treatment option in such an emergency situation or as a rescue procedure when aortic pathology is involved near the supra-aortic vessels.

No MeSH data available.


Related in: MedlinePlus

The CT scan revealed a Stanford type B aortic dissection combined with a huge aneurysmal dilatation for which the entry site was the aortic arch level and the aneurysm extended to the infrarenal level and ran to the common iliac artery.
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Figure 3: The CT scan revealed a Stanford type B aortic dissection combined with a huge aneurysmal dilatation for which the entry site was the aortic arch level and the aneurysm extended to the infrarenal level and ran to the common iliac artery.

Mentions: A 75-year-old male with hypertension and medically treated aortic dissection that occurred several years ago again presented with severe chest and back pain. A CT scan revealed an aortic dissection (Stanford type B) combined with a massive aneurysmal dilatation, and the intimal tear site was nearly 2 cm from the left suclavian artery. Because the aortic aneurysm involved an aortic arch, the proximal landing zone was less than 1 cm wide (Fig. 3). Because of his age and the characteristics of the lesion, there was the possibility of further operation related complication (perioperative mortality, morbidity, stroke, paraplegia etc.) and the patient did not want open surgery; we therefore decided to perform TEVAR rather than open surgery. The patient was taken to the cardiac catheterization laboratory and an arteriotomy for the left femoral artery was performed under general anesthesia. The 035 inch wire was placed in the ascending aorta and the left subclavian artery through the left radial approach. The aortogram confirmed a large aortic aneurysm adjacent to the origin of the left subclavian artery. Two thirds of the origin of the left common carotid artery was covered by the proximal part of a 40×160 mm SEAL thoracic aortic stent (S&G biotech, Seongnam, Korea) to achieve an adequate landing zone. Another 40×130 mm SEAL thoracic aortic stent (S&G biotech, Seongnam, Korea) was deployed in the first aortic stent graft with a 7 cm overlapped segment to protect against disconnection of the aortic stent grafts. After selection of the left common carotid artery using a 5 Fr Judkin right catheter through the gap between the stent graft and the left carotid artery, we passed a 035 inch Amplatz stiff wire into the left carotid artery through the right femoral artery. An 8×60 mm SMART nitinol stent (Cordis, Hialeah, FL, USA) was then deployed into the left common carotid artery. The final angiogram showed excellent results with good flow to both the thoracic aorta and the left common carotid artery. No endoleak was noted (Fig. 4). On the clinical follow-up of this patient (20 months to date), the patient has had no problems related to the graft and the follow-up CT scan showed no sign of malfunctioning grafts, restenosis of the stent in the left carotid artery or other complications.


The modified chimney technique with a thoracic aortic stent graft to preserve the blood flow of the left common carotid artery for treating descending thoracic aortic aneurysm and dissection.

Lee KN, Lee HC, Park JS, Kim BW, Cha KS, Kim SP, Lee CW, Kim HK - Korean Circ J (2012)

The CT scan revealed a Stanford type B aortic dissection combined with a huge aneurysmal dilatation for which the entry site was the aortic arch level and the aneurysm extended to the infrarenal level and ran to the common iliac artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369971&req=5

Figure 3: The CT scan revealed a Stanford type B aortic dissection combined with a huge aneurysmal dilatation for which the entry site was the aortic arch level and the aneurysm extended to the infrarenal level and ran to the common iliac artery.
Mentions: A 75-year-old male with hypertension and medically treated aortic dissection that occurred several years ago again presented with severe chest and back pain. A CT scan revealed an aortic dissection (Stanford type B) combined with a massive aneurysmal dilatation, and the intimal tear site was nearly 2 cm from the left suclavian artery. Because the aortic aneurysm involved an aortic arch, the proximal landing zone was less than 1 cm wide (Fig. 3). Because of his age and the characteristics of the lesion, there was the possibility of further operation related complication (perioperative mortality, morbidity, stroke, paraplegia etc.) and the patient did not want open surgery; we therefore decided to perform TEVAR rather than open surgery. The patient was taken to the cardiac catheterization laboratory and an arteriotomy for the left femoral artery was performed under general anesthesia. The 035 inch wire was placed in the ascending aorta and the left subclavian artery through the left radial approach. The aortogram confirmed a large aortic aneurysm adjacent to the origin of the left subclavian artery. Two thirds of the origin of the left common carotid artery was covered by the proximal part of a 40×160 mm SEAL thoracic aortic stent (S&G biotech, Seongnam, Korea) to achieve an adequate landing zone. Another 40×130 mm SEAL thoracic aortic stent (S&G biotech, Seongnam, Korea) was deployed in the first aortic stent graft with a 7 cm overlapped segment to protect against disconnection of the aortic stent grafts. After selection of the left common carotid artery using a 5 Fr Judkin right catheter through the gap between the stent graft and the left carotid artery, we passed a 035 inch Amplatz stiff wire into the left carotid artery through the right femoral artery. An 8×60 mm SMART nitinol stent (Cordis, Hialeah, FL, USA) was then deployed into the left common carotid artery. The final angiogram showed excellent results with good flow to both the thoracic aorta and the left common carotid artery. No endoleak was noted (Fig. 4). On the clinical follow-up of this patient (20 months to date), the patient has had no problems related to the graft and the follow-up CT scan showed no sign of malfunctioning grafts, restenosis of the stent in the left carotid artery or other complications.

Bottom Line: The main limitation is related to the anatomical difficulties when disease involves the aortic arch.A fenestrated, branched aortic stent graft and hybrid operation has been introduced to overcome this limitation, but it is a custom-made device and is time consuming to manufacture.Furthermore, these devices cannot be used in an emergency setting.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Pusan National University College of Medicine, Busan, Korea.

ABSTRACT
While thoracic endovascular aortic repair is an effective treatment option for descending thoracic aorta pathology, it does have limitations. The main limitation is related to the anatomical difficulties when disease involves the aortic arch. A fenestrated, branched aortic stent graft and hybrid operation has been introduced to overcome this limitation, but it is a custom-made device and is time consuming to manufacture. Furthermore, these devices cannot be used in an emergency setting. We report two patients with massive descending thoracic aortic aneurysm and ruptured aortic dissection very near the aortic arch who underwent a procedure which we named the modified chimney technique. The modified chimney technique can be used as a treatment option in such an emergency situation or as a rescue procedure when aortic pathology is involved near the supra-aortic vessels.

No MeSH data available.


Related in: MedlinePlus