Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch.
OBJECTIVE
To summarize our early experience gained from the chimney technique for type B aortic dissection (TBAD) extending to the aortic arch and to evaluate the aortic remodeling in the follow-up period.


METHODS
From September 2011 to July 2014, 27 consecutive TBAD patients without adequate proximal landing zones were retrograde analyzed. Chimney stent-grafts were deployed parallel to the main endografts to reserve flow to branch vessels while extending the landing zones. In the follow-up period, aortic remodeling was observed with computed tomography angiography.


RESULTS
The technical success rate was 100 %, and endografts were deployed in zone 0 (n = 3, 11.1 %), zone 1 (n = 18, 66.7 %), and zone 2 (n = 6, 22.2 %). Immediately, proximal endoleaks were detected in 5 patients (18.5 %). During a mean follow-up period of 17.6 months, computed tomography angiography showed all the aortic stent-grafts and chimney grafts to be patent. Favorable remodeling was observed at the level of maximum descending aorta and left subclavian artery with expansion of true lumen (from 18.4 ± 4.8 to 25 ± 0.86 mm, p < 0.001 and 27.1 ± 0.62 to 28.5 ± 0.37 mm, p < 0.001) and depressurization of false lumen (from 23.7 ± 2.7 to 8.7 ± 3.8 mm, p < 0.001, from 5.3 ± 1.2 to 2.1 ± 2.1 mm, p < 0.001). While at the level of maximum abdominal aorta, suboptimal remodeling of the total aorta (from 24.1 ± 0.4 to 23.6 ± 1.5 mm, p = 0.06) and true lumen (from 13.8 ± 0.6 to 14.5 ± 0.4 mm, p = 0.08) was observed.


CONCLUSION
Based on our limited experience, the chimney technique with thoracic endovascular repair is demonstrated to be promising for TBAD extending to the arch with favorable aortic remodeling.
['Huang|Chen|C|', 'Tang|Hanfei|H|', 'Qiao|Tong|T|', 'Liu|Changjian|C|', 'Zhou|Min|M|']
D000368:Aged D000369:Aged, 80 and over D000784:Aneurysm, Dissecting D001013:Aorta, Thoracic D017545:Aortic Aneurysm, Thoracic D019917:Blood Vessel Prosthesis Implantation D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D015607:Stents D014057:Tomography, X-Ray Computed D016896:Treatment Outcome
Chimney technique Type B aortic dissection Aortic arch Aortic remodeling Endovascular repair