The Particulars: Thoracic endovascular aortic repair (TEVAR) has emerged as an acceptable treatment for thoracic aortic diseases and typically involves a hybrid approach. Singular approaches—including the use of a parallel graft, or chimney, to revascularize target vessels—are used in emergencies and other select cases. Use of chimney grafts in elective procedures has not been well documented.

Data Breakdown: Italian researchers used chimney stents in patients with aortic arch tear, type B aortic dissection, a type 1 endoleak from a previous TEVAR, and penetrating aortic ulcer. Emergency treatment was provided to about one-quarter of patients. Technical success was achieved in 100% of cases, with no endoleaks. Chimney stents were associated with a perioperative mortality rate of 3.8%, and supra-aortic vessel patency was obtained in all patients. Both mortality and chimney graft complication rates were 15.4%. During an average 36.8 months follow-up, 23% of patients developed type 1 endoleaks.

Take Home Pearl: The chimney technique for aortic arch pathologies appears to be relatively safe and feasible in patients who are at high risk for surgery or who are ineligible for conventional TEVAR.