Late retrograde migration of a left subclavian artery chimney stent-graft into the innominate artery

Marco Leopardi, Yamume Tshomba, Alessandro Castiglioni, Domenico Baccellieri, Andrea Kahlberg, Giampiero Negri, Germano Melissano, Roberto Chiesa

Research output: Contribution to journalArticle

Abstract

Purpose: To report an uncommon case of chimney stent-graft migration in the aortic arch. Case Report: A 29-year-old man presented with chronic left arm hyposthenia after late displacement and thrombosis of a left subclavian artery (LSA) chimney graft that migrated retrogradely into the innominate artery 2 years after deployment. The self-expanding LSA chimney was placed during a redo procedure to repair a pseudoaneurysm and type I endoleak after an index emergency thoracic endovascular aortic repair for traumatic aortic rupture 1 year earlier. The patient was successfully treated in an elective procedure via a median sternotomy, with arch aortotomy under circulatory arrest to remove the proximal end of the thrombosed chimney graft from the ostium of the innominate trunk. Three months later, a left carotid-to-subclavian bypass was performed to restore flow to the left arm. Conclusion: Migration of the proximal end of an overly long chimney graft that moved freely in the aortic arch exposed the patient to a high risk of stroke and death. Because of the high-risk situation, open repair under circulatory arrest was elected to remove the proximal end of the chimney graft, with no major complications.

Original languageEnglish
Pages (from-to)666-669
Number of pages4
JournalJournal of Endovascular Therapy
Volume23
Issue number4
DOIs
Publication statusPublished - Aug 1 2016

Keywords

  • Aortic isthmic rupture
  • Chimney technique
  • Innominate artery
  • Left subclavian artery
  • Open surgery
  • Stent-graft migration
  • Thoracic endovascular aortic repair

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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