Korean Circ J.  2012 May;42(5):360-365. 10.4070/kcj.2012.42.5.360.

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

• KMID: 2028768
• DOI: http://doi.org/10.4070/kcj.2012.42.5.360

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.

Keyword

Stents; Aortic rupture; Aortic aneurysm

MeSH Terms

Aorta, Thoracic
Aortic Aneurysm
Aortic Aneurysm, Thoracic
Aortic Rupture
Carotid Artery, Common
Chimera
Emergencies
Humans
Stents
Transplants

Figure

• 

  Fig. 1 CT showed a Stanford type B aortic dissection and intramural hematoma at the thoraco-abdominal aorta (A-D). An intimal flap was noted just distal from the left subclavian artery (white arrow in E and F). The intramural hematoma extended to the origin of the renal artery (C).

• 

  Fig. 2 The overall procedure of the patient. A: the aortogram before stent graft deployment; the proximal entry tear was distal to the LSCA. B: the aortogram after stent graft deployment; the proximal entry tear was completely sealed. The origins of the left carotid artery and LSCA were covered because of the short proximal landing zone. C: selection of the LCCA with a Judkin right 5 Fr catheter through the right femoral artery. D: stent deployment in the LCCA by the chimney graft technique. E: the aortogram after successful stent graft deployment; the occluded true lumen was reexpanded and the false lumen was not seen. The mean pressure gradient between the thoracic and abdominal aorta was decreased to 20 mm Hg from 90 mm Hg after TEVAR. There was no endoleak. TEVAR: thoracic endovascular aortic repair, LSCA: left subclavian artery, LCCA: left common carotid artery.

• 

  Fig. 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.

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  Fig. 4 The overall procedure of the patient. A and B: the aortogram before stent graft deployment; the proximal entry tear was distal to the LSCA and there was a huge aneurysm. C: the aortogram after stent graft deployment; the huge aneurysm was completely sealed. The origins of the left carotid artery and LSCA were covered because of the short proximal landing zone. D: selection of the LCCA with a Judkin right 5 Fr catheter through the right femoral artery. E: stent deployment in the LCCA by the chimney graft technique. F: the aortogram after successful stent graft deployment: There was no endoleak. LSCA: left subclavian artery, LCCA: left common carotid artery.

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