• Michel J Bosiers, Konstantinos P Donas, Nicola Mangialardi, Giovanni Torsello, Vincent Riambau, Frank J Criado, Frank J Veith, Sonia Ronchey, Stefano Fazzini, and Mario Lachat.
• Department of Vascular and Endovascular Surgery, University of Münster, Münster; Department of Vascular Surgery, St. Franziskus-Hospital Münster, Münster, Germany.
• Ann. Thorac. Surg. 2016 Jun 1; 101 (6): 2224-30.

BackgroundTo study the performance of the chimney technique in the treatment of aortic arch pathologic conditions.MethodsWe retrospectively evaluated the clinical and procedural outcome data of patients undergoing endovascular treatment in the aortic arch by use of the chimney technique at four European centers between June 2002 and December 2014. The primary endpoint was technical success. The secondary endpoints were type I endoleak, 30-day mortality, stroke, primary patency of the chimney graft, and freedom from reintervention.ResultsNinety-five patients were included in the study. The underlying pathologic conditions were degenerative aneurysm (n = 45, 47.4%), type B aortic dissection (n = 30, 31.6%), dissecting aneurysm (n = 6, 6.5%), penetrating atherosclerotic ulcer (n = 5, 5.3%), type I endoleak after previous thoracic endovascular aortic repair (n = 6, 6.3%), and aortic embolic disease (n = 3, 3.2%). Twenty-one patients (22%) underwent arch-branch debranching before chimney graft implantation. The majority of patients were treated electively (n = 49, 51.6%). Forty-six patients (48.4%) underwent urgent placement of chimney grafts because of their symptoms (n = 25) or rupture (n = 21). Technical success was 89.5%. The 30-day mortality was 9.5% (9 patients). No aorta-related death was observed. A type Ia endoleak occurred in 10 patients (10.5%) intraoperatively, resolving spontaneously within the first 30 days in 50% of these cases. Major stroke was diagnosed in 2 patients (2%). Primary patency of the chimney grafts was 98%, and 5 patients (5.2%) required a reintervention.ConclusionsThe chimney technique in the aortic arch proved highly and predictably successful, with a low rate of reinterventions.Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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