Related Experiment Video
Updated: Dec 27, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Chimney stent graft for left subclavian artery preservation during thoracic endograft placement
Andre Ramdon1, Ramkrishna Patel1, Jeffrey Hnath1
1Vascular Group, The Institute for Vascular Health & Disease, Albany Medical College/Albany Medical Center Hospital, Albany, NY.
Insights
Chimney stent grafting (CSG) provides similar outcomes to carotid to subclavian artery bypass (CSB) for revascularizing the left subclavian artery during thoracic endovascular aortic repair (TEVAR). This minimally invasive approach offers equivalent results to open bypass.
Area of Science:
- Vascular Surgery
- Endovascular Repair
- Aortic Aneurysm Treatment
Background:
- Carotid to subclavian artery bypass (CSB) is the established method for left subclavian artery revascularization during thoracic endovascular aortic repair (TEVAR).
- Evaluating alternative techniques for left subclavian artery revascularization during TEVAR is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the outcomes of chimney stent grafting (CSG) versus carotid to subclavian artery bypass (CSB) for left subclavian artery revascularization during TEVAR.
- To determine if CSG is a viable alternative to open bypass in this context.
Main Methods:
- Retrospective review of a vascular surgery registry from February 2011 to September 2017.
- Analysis of 81 patients undergoing left subclavian revascularization during elective TEVAR, comparing CSB (n=64) and CSG (n=17).
- Evaluation of demographics, procedural details, perioperative outcomes, and long-term patency.
Main Results:
- No significant differences in perioperative occlusions, ischemic events, length of stay, or mortality between CSB and CSG groups.
- CSG group had no left hemispheric strokes, while the CSB group had 6%.
- Similar long-term patency rates were observed, with only one occlusion in the CSB group.
Conclusions:
- Chimney stent grafting (CSG) is a safe and effective alternative to carotid to subclavian artery bypass (CSB) for left subclavian artery revascularization during TEVAR.
- CSG offers equivalent results to open bypass, representing a less invasive option.
- Further research may explore wider adoption of CSG in select patient populations.
Objective:
Carotid to subclavian artery bypass (CSB) has been the standard for revascularizing the left subclavian artery during coverage by thoracic endovascular aortic repair (TEVAR). The purpose of this study is to determine if a chimney stent graft (CSG) offers similar outcomes as an alternative to open bypass.
Methods:
A retrospective review of a single vascular surgery registry between February 2011 and September 2017 was performed of all left subclavian revascularization during elective TEVAR. Arch reconstructions involving more than just the left subclavian artery were excluded. Indications, demographics, procedural details, and outcomes were analyzed using standard statistical analysis.
Results:
Eighty-one patients with a mean age of 68 years (range, 32-87 years) had left subclavian revascularization (64 [79%] CSB vs 17 [21%] CSG) during TEVAR. Median follow-up for CSG was 8 months (range, 0-52 months) and for CSB was 14.5 months (range, 3-72). Demographics between the groups were similar except for more males in both groups (43 [67%] in CSB vs 10 [59%] in CSG; P = .28). The CSB group had significantly more aneurysms than dissections compared with CSG (45 [70%] vs 6 [35%]; P = .008). There were no perioperative occlusions or ischemic issues for either group in the perioperative period. Postoperative hematoma rates trended higher in the CSB (7.11% vs 1.6%; P = .53) with three (4.6%) of the CSB requiring evacuation of hematoma. Left hemispheric strokes were 6% in the CSB with none occurring in the CSG group. Perioperatively, the CSB group had one recurrent laryngeal nerve and one graft infection. Length of stay was similar in both groups (CSB, 8.4 days vs CSG, 9.1 days). Perioperative mortality was not statistically significant between both groups with two deaths (3%) in the CSB and none in the CSG group. No gutter leaks were identified on follow-up computed tomography scan during long-term follow-up. Patency rates were similar with only one occlusion in the CSB group at 23 months.
Conclusions:
Left common carotid to subclavian artery bypass has been the standard for revascularization of the left subclavian artery during coverage by TEVAR. Chimney stent grafting to perfuse the left arm appears to offer equivalent results as a minimally invasive alternative.
