Chimney grafts in aortic occlusive disease

The aim of this article was to present juxtavisceral aortic occlusive disease with particular reference to a novel therapeutic approach, namely protected stenting by means of so called chimney grafts. The juxta renal aortic occlusion is the last aortoiliac occlusive lesion not to be stented routinely because of the risk for trash and/or need for overstenting of vital aortic side branches. The risk for trash also exists in open repair which makes it particularly challenging in this setting. The patients have advanced atherosclerosis and are poor risks for major surgery. A safe endovascular approach is therefore desirable. These lesions are either predominantly thrombotic or heavily calcified plaques. The thrombotic lesions can be stented under protection of the visceral branches by temporary occlusion balloons. The calcified lesions, on the other hand, require overstenting of the visceral vessels that then need to be preserved by chimney grafts. These endovascular procedures are complex and time consuming but they are associated with less surgical trauma and hence improved morbidity, mortality and recovery. The median term results of chimney grafts are encouraging, although more patients and longer follow-up are still needed.