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ludc webb

Nuno Dias

Associate professor

ludc webb

Chimney grafts preserve visceral flow and allow safe stenting of juxtarenal aortic occlusion.

Author

  • Adel Bin Jabr
  • Björn Sonesson
  • Bengt Lindblad
  • Nuno Dias
  • Tim Resch
  • Martin Malina

Summary, in English

OBJECTIVE: Chimney grafts have proven useful for urgent endovascular repair of juxtarenal aortic aneurysms. Stenting of juxtarenal aortic occlusive disease is not routinely advocated due to the risk of visceral artery obstruction. We report on the potential applicability of chimney grafts in 10 patients with juxtarenal aortic stenosis or occlusion. To our best knowledge, chimney grafts have not been applied previously in this challenging setting. METHODS: Ten high-risk female patients (mean age, 68 years) with severe stenosis or occlusion of the aorta at the level of the visceral arteries were offered stenting. "Chimney" stents or stent grafts (20-40 mm long) were implanted from a brachial approach into visceral arteries that needed to be covered by the aortic stent. The chimney stents were then temporarily obstructed by balloon catheters to prevent visceral embolization until the aortic stent or stent graft was deployed. RESULTS: All procedures were technically successful, and patency was obtained in all visceral arteries and the aorta without distal embolization. One patient died after 9 days of acute heart failure. The nine surviving patients presented no complications, and all stented vessels remained patent at up to 6 years. Another patient died after 5.5 years due to lung cancer. All three patients with renal impairment have improved renal function, and a reduction in antihypertensive medication has been possible. CONCLUSIONS: Chimney grafts may allow stenting of juxtarenal aortic occlusive disease by protecting the patency of visceral arteries. Further evaluation with more patients and longer follow-up is required.

Department/s

  • Department of Clinical Sciences, Malmö
  • Vascular Diseases - Clinical Research

Publishing year

2012-12-07

Language

English

Publication/Series

Journal of Vascular Surgery

Document type

Journal article

Publisher

Mosby

Topic

  • Cardiac and Cardiovascular Systems

Status

Published

Research group

  • Vascular Diseases - Clinical Research

ISBN/ISSN/Other

  • ISSN: 1097-6809