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Chimney grafts preserve visceral flow and allow safe stenting of juxtarenal aortic occlusion  Adel Bin Jabr, MD, Björn Sonesson, MD, PhD, Bengt Lindblad,

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Presentation on theme: "Chimney grafts preserve visceral flow and allow safe stenting of juxtarenal aortic occlusion  Adel Bin Jabr, MD, Björn Sonesson, MD, PhD, Bengt Lindblad,"— Presentation transcript:

1 Chimney grafts preserve visceral flow and allow safe stenting of juxtarenal aortic occlusion 
Adel Bin Jabr, MD, Björn Sonesson, MD, PhD, Bengt Lindblad, MD, PhD, Nuno Dias, MD, PhD, Tim Resch, MD, PhD, Martin Malina, MD, PhD  Journal of Vascular Surgery  Volume 57, Issue 2, Pages (February 2013) DOI: /j.jvs Copyright © 2013 Society for Vascular Surgery Terms and Conditions

2 Fig 1 The two main types of juxtarenal aortic occlusive diseases. A, Coral reef plaques. B, Distal aortic thrombosis, usually caused by iliac obstruction. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Stenting a juxtarenal aortic occlusion without applying the “chimney technique” carries a risk of visceral occlusion. A, Intraoperative angiogram during stent deployment. B, After stent deployment, the left renal artery is occluded by emboli. C, Restored renal perfusion after on-table thrombolysis and renal stenting. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

4 Fig 3 Intraoperative angiography of midaortic stenting with chimney technique. A, Undeployed stents parked in the superior mesenteric and both renal arteries from a brachial approach. B, Undeployed aortic stent has been added (arrowhead). C, Visceral stents have been deployed, and the balloons are kept inflated in order to protect the viscera from aortic debris until aortic flow is reestablished. D, The aortic stent has been deployed and is dilated while the visceral balloons are still in place. E, All visceral and aortic stents have been deployed. The visceral balloons were deflated after reestablishment of aortic flow. The visceral stents protrude slightly above the aortic stent. F, Completion angiography demonstrates patent renal, mesenteric, and aortic stents with no residual stenosis. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

5 Fig 4 Patient with excessive midaortic (and iliac) calcification (arrows) stented with chimneys in the right (RR) and left renal (LR) and superior mesenteric arteries (SMA). A, Completion angiography. B, Follow-up computed tomography at 18 months. The CT demonstrates how the massive aortic plaque is pushed posteriorly by the aortic stent (A). The final aortic diameter of 8 mm proved sufficient for this patient, who had external iliac arteries only 5 mm in diameter (not shown). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

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