BACKGROUND: The advent of branched and fenestrated aortic endografts has facilitated the treatment of increasingly complex aortic pathology. The management of complications and @entity1070 involving the branches and fenestrations of these grafts represents an increasingly significant clinical and technical challenge. METHODS: A 79-year-old @entity1 developed a @entity395 from a tear in the graft fabric immediately posterior to the celiac axis branch 3  years after the placement of an off-the-shelf branched endograft for a @entity2334 . The @entity1 presented urgently with @entity490 and a maximal @entity439 diameter of 15.3  cm. RESULTS: The operative plan was to create a chimney graft completely within the original branched endograft to cover the defect and maintain celiac branch flow. The celiac trunk was accessed from a left axillary approach and access for the main endograft body was achieved via the left femoral artery. Two balloon-expandable covered stents were deployed from the celiac branch extending into the main endograft as a chimney and molded to 2 aortic extension cuffs to cover the @entity154 . The resultant configuration was a modified-sandwich graft within the original stent graft and resulted in successful exclusion of the endoleak. Postoperative imaging at 1, 6, and 12  months has demonstrated continued patency of the celiac trunk, no further endoleak, and a 16-mm reduction in @entity439 size. CONCLUSIONS: The chimney technique was successfully applied as an endovascular option to salvage a multibranched endograft with a significant and anatomically unfavorable defect. Careful follow-up and additional clinical study are required to clarify the role of off-the-shelf solutions in complex endoleak management.

Using a Chimney to Make a Sandwich: Salvage of a Multibranched Thoracoabdominal Aortic Endograft with a XXXX .

@entity1 :: ('9606', 'Species') :: ['woman', 'patient'] @entity154 :: ('MESH:D000013', 'Disease') :: ['fabric defect'] @entity1070 :: ('MESH:D057867', 'Disease') :: ['endoleaks'] @entity2334 :: ('MESH:D017545', 'Disease') :: ['type II thoracoabdominal aortic aneurysm'] @entity439 :: ('MESH:D000783', 'Disease') :: ['aneurysm'] @entity490 :: ('MESH:D015746', 'Disease') :: ['abdominal pain'] @entity395 :: ('MESH:D035583', 'Disease') :: ['rare type IIIb endoleak']
@entity1070 :: (MESH:D057867,Disease) :: ['Type IIIb Endoleak']
