The application of 'chimney' technique of left subclavian artery in performing endovascular repair procedure for Stanford type B aortic dissection

Objective: To investigate the application of 'chimney' technique of left subclavian artery in performing endovascular repair procedure for Stanford type B aortic dissection, and to discuss its technical points. Methods: A total of 35 patients with Stanford type B aortic dissection confirmed by clinical and imaging manifestations were enrolled in this study. In all the patients, the left subclavian artery was involved by dissection (the distance between the first laceration and the opening of left subclavian artery was less than 15 mm), the left vertebral artery was the dominant form, or the Willis ring was insufficiently compensatory. The disease was evaluated by CTA and DSA. During the performance of endovascular aortic repair, the left subclavian artery was covered with covered-stent, which was followed by balloon insertion and dilation by using 'chimney' technique to reconstruct the left subclavian artery. Results: The placement of aortic covered-stent and balloon-assisted stenting of subclavian artery were successfully accomplished in all the 35 cases. All the patients were followed up for 3-24 months, and the left subclavian artery 'chimney' stent was patent. Conclusion: In the performance of endovascular repair for Stanford type B aortic dissection, the selection of the normal aortic wall as the anchor area of the proximal segment of covered-stent can reduce the occurrence of secondary iatrogenic dissection. The 'chimney' technique of left subclavian artery combined with endovascular aortic repair procedure is a safe and effective treatment for Stanford type B aortic dissection; this technique can reliably prevent 'blood stealing symptom' from occurring. (authors)