Chimney grafts to perfuse functionally important inferior mesenteric arteries not in a stent-graft landing zone: The missing clinical relevance is still of concern

摘要

In the beginning, the use of a chimney graft was sporadic. In 2003, Roy Greenberg was the first to report the use of self-expanding stents to "raise the effective renal artery origin in conjunction with an endovascular graft." Two years later, Thomas Larzon intentionally used a balloon-expandable stent to maintain perfusion through the left common carotid artery, extending the proximal landing zone for a thoracic stent-graft in a patient with aortic arch aneurysm. Clinical use of chimney grafts has increased steadily since because they are readily available (using standard off-the-shelf endovascular tools and materials) and add little time to the endovascular aneurysm repair (EVAR) procedure. Moreover, there are few anatomical limitations. There are reports of high technical success rates with low mortality and morbidity. The use of these parallel grafts (chimney, periscope, or sandwich) has proven to be feasible, safe, and effective with encouraging midterm results, but the indications for use of parallel grafts are not yet fully defined.