Use of Chimney graft after accidental coverage of the left common carotid artery in TEVAR procedure

Background: Thoracic endovascular aneurysm repair (TEVAR) is currently the therapy of first choice for most thoracic aortic disease. Because aortic stent grafts are placed in the vicinity of aortic side branches, unintentional coverage of these arteries may occur. Case report: We report a case of a 69-year-old male with an asymptomatic penetrating ulcer of the aortic arch, based at the origin of the left subclavian artery. Due to his medical story, we decided to perform an endovascular procedure with placement of a stent graft in the left hemi-ach wit previous left common carotid subclavian bypass. During the deployment of the aortic stent graft, the proximal margin of the stent graft displaced, inadvertly covering the origin of the left common carotid artery. As a bail out procedure, we successfully revascularized the left common carotid artery with the use of the chimney technique. Conclusion: Endovascular treatment of aortic disease has gained popularity over the last decade. Despite increasing experience, these procedures remain technically challenging. Unintentional coverage of main aortic side branches during TEVAR is a serious complication, which requires immediate intervention. The chimney technique offers a minimal invasive procedure in such case, with promising results.