Periscopes, chimneys, sandwich and VORTEC to facilitate abdominal and thoracoabdominal aortic aneurysm repair

Abstract

The VORTEC (VIABAHN open revascularization technique) and the chimney graft technique are tools with which to maintain or restore blood flow to the aortic branches and can be used intentionally or as a bailout procedure in open surgery or endovascular procedures. VORTEC is a stent graft-based vascular connection technique that achieves end-to-end anastomosis configuration; it is especially useful when the traditional suture technique proves (can be) cumbersome. It is also a speedy tool with virtually no blood flow interruption and no anastomotic bleeding, and patency rates compare favorably with sutured anastomosis. The chimney/periscope, as well as the sandwich graft technique (CHIMPES), is an endovascular tool using parallel endografts for maintaining or restoring blood flow to aortic branches, whereas the conventional aortic stent graft will land above their origin. It is a relatively speedy procedure allowing the use of off-the-shelf devices, even for emergency cases. When parallel grafts run in between two aortic stent graft devices, the term“sandwich” is used. Based on the published experience, both techniques seem particularly useful in aortic arch and thoracoabdominal aortic aneurysm repair, especially in high-risk or acute cases.