24th ASMIHA Coverage: Fenestrated Stent Graft versus Multiple Chimney in Aneurysm of Aortic Arch
JAKARTA --- Aneurysms and aortic dissection, except those involving the ascending aorta, can be done by endovascular technique. The advantage of this technique is less invasive than surgery so that the treatment of choice in older patients with comorbidities and aneurysms involving pararenal vessels.
Involving endovascular aortic arch has a high difficulty level because they involve one or more branches of the aorta namely innominata artery, the left subclavian and left carotid artery. The third branch's patency must be maintained by not covering the stent graft and making a chimney or fenestrated stent graft. Fenestrated stent graft stent graft is made by punching holes right on the branches of the aorta. The advantage of this technique is that it can be adjusted for each patient. Meanwhile, chimney stent graft is a technique to maintain the branches of the aorta by means of another stent as a chimney which attach to the main stent graft.
Advantages and disadvantages of these techniques are discussed in a debate. Invited speakers from abroad two and four panelists from within the country, the first session presented by Prof. Lee Han Choel, MD, PhD from Pusan National University, Korea , the excess fenestrated stent graft. The advantages of this technique is that it can be done without involving surgery and more physiological. In addition, the stent graft can be made in accordance with the anatomy of the blood vessels. Although it can be used for multiple visceral blood vessels, but this procedure has the disadvantage that not being able to reach all parts of the aorta, there is the potential for migration, can not be used when the emergency, and the cost is quite expensive because it must be done in a taylor made for each patient.
The next session was continued by Prof. Su Chang, MD, PhD, of China Medical University, who delivered the statistical data and experiences concerning chimney technique. This method difference with fenestrated stent graft is the installation of an additional stent in the main stent graft. The stent in the aorta branches to maintain cerebral perfusion (branches of the carotid) and upper arms (subclavian branch). In contrast with fenestrated stent graft technique, this technique can reach all parts of the aorta is concerned but may increase the risk of occlusion, compression, and there is a gap between the stent to the aortic wall thereby increasing the risk of endoleak. This technique is also sometimes requires surgery to put a stent carotid area carotid or if required inter-carotid shunt.
Suko Adiarto, MD, PhD and Dicky Aligheri, MD present as moderator and give a conclusion at the end of the debate session. Whatever the technique used, they still need Double Anti-Platelet Therapy for 3 -6 months after measures to prevent stent thrombosis and thromboembolism. In addition, more research is needed to compare the long-term outcome of both and discussion regarding the use of protection devices in the carotid artery to prevent the risk of stroke is high enough post-action. The message for clinicians: endovascular technique is very feasible for elderly patients at high risk for surgery.
Modified from Media Aesculapius by KM, Edited by Su