The Chimney Technique

A thoracic chimney graft is a stent or stent graft that is deployed in a supraaortic branch vessel, protruding somewhat proximally into the free aortic lumen like a chimney parallel to the main aortic stent graft. The chimney graft is used to preserve flow to vital aortic side branches covered by the main aortic stent graft. Standard off-the-shelf stent grafts can be used to instantly treat lesions with inadequate fixation zones. The chimney graft offers an alternative to fenestrated stent grafts in urgent cases, in aneurysms with challenging neck anatomy, and in thoracic endovascular aortic repair for reconstituting an unintentionally covered aortic side branch. We describe our experience with this technique and review the current literature. More data and further technical improvements are necessary before the chimney graft can be widely advocated.