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Patient 1
AN ARTICLE PUBLISHED BY THE 2012 EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2013;45(1):28-35, TRIPLE-BARREL GRAFT AS A NOVEL STRATEGY TO PRESERVE SUPRA-AORTIC BRANCHES IN ARCH-TEVAR PROCEDURES: CLINICAL STUDY AND SYSTEMATIC REVIEW REVIEWED THE OUTCOMES OF EARLY EXPERIENCE WITH TOTAL ENDOVASCULAR REPAIR OF AORTIC-ARCH ANEURYSM USING DOUBLE CHIMNEY-GRAFTS. AVAILABLE ONLINE (B)(4) 2012. IN REVIEW OF THE PUBLISHED LITERATURE THE FOLLOWING FINDINGS WERE NOTED: DURING (B)(6) 2010 THROUGH (B)(6) 2012 THE DOUBLE CHIMNEY-GRAFT TECHNIQUE WAS PERFORMED IN SIX MALE PATIENTS ((B)(6)), WITH CONTAINED RUPTURED ANEURYSM, DISSECTING ANEURYSM, PSEUDOANEURYSM, PENETRATING AORTIC ULCER AND PROXIMAL ENDOLEAK AFTER TEVAR. IN ALL CASES, ALL SUPRA-AORTIC VESSELS HAD TO BE COVERED WITH AORTIC STENT-GRAFT TO RECEIVE A SUFFICIENT LANDING AND SEALING ZONE. CHIMNEY-GRAFTS WERE INTRODUCED TO THE ASCENDING AORTA SLIGHTLY DEEPER THAN THE THORACIC STENT-GRAFTS THROUGH THE CUT-DOWN EXPOSURE OF THE COMMON CAROTID ARTERIES. WE DEPLOYED AORTIC STENT GRAFTS AND SELF-EXPANDABLE CHIMNEY-GRAFTS SIMULTANEOUSLY AND SUCCESSFULLY. THE USE OF DOUBLE CHIMNEY-GRAFTS IS POSSIBLE IN HIGH-RISK PATIENTS WHERE THE PROXIMAL LANDING ZONE OF ENDOGRAFT WOULD BE IN ZONE 0. THE ARTICLE REPORTS PATIENT NUMBER FOUR UNDERWENT REPAIR WITH GORE TAG THORACIC ENDOPROSTHESIS ON (B)(6) 2012. THE PATIENT TOLERATED THE PROCEDURE. ON (B)(6) 2012, PATIENT UNDERWENT RE-INTERVENTION AND ADDITIONAL AORTIC STENT-GRAFT WAS PLACED FURTHER PROXIMALLY IN THE ASCENDING AORTA. ADDITIONAL BALLOON MODELING OF ALL STENT-GRAFTS WAS PERFORMED AND THE ENDOLEAK RESOLVED. TWO YEAR LATER, THIS PATIENT PRESENTED WITH CHEST PAIN AND AN INFECTED STERNAL FISTULA WITH BLOOD SECRETION. THE CT REVEALED A PSEUDOANEURYSM OF AORTIC ARCH FROM THE CANNULATION POINT DURING THE CABG CONNECTED TO THE STERNAL FISTULA.