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Single-center experience with an inner branched arch endograft
- Source :
- Journal of Vascular Surgery. 69:977-985.e1
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Objective Whereas open repair is the "gold standard" for most aortic arch diseases, a subgroup of patients might benefit from an endovascular approach. The introduction of branched stent grafts with dedicated design to address the challenges of the ascending aorta and the aortic arch has opened an entirely new area of treatment for these patients. We investigated the early outcomes of branched thoracic endovascular aortic repair (b-TEVAR) in various types of disease of the aortic arch. Methods A retrospective analysis was conducted of prospectively collected data from a single center of all consecutive patients treated with b-TEVAR. The indication for elective endovascular repair was consented in an interdisciplinary case conference. All patients were treated with a custom-made inner branched arch endograft with two internal branches (Cook Medical, Bloomington, Ind) and left-sided carotid-subclavian bypass. Study end points were technical success, 30-day mortality, and complications as well as late complications and reinterventions. Results Between 2012 and 2017, there were 54 patients (38 male; median age, 71 years) treated with diseases of the aortic arch. Indications for therapy involved degenerative aortic arch or proximal descending aortic aneurysms requiring arch repair (n = 24), dissection with or without false lumen aneurysms (n = 26), and penetrating aortic ulcers (n = 4). Forty-three cases (80%) were performed electively and 11 urgently for contained ruptures (n = 3) or symptomatic aneurysms (n = 8) with endografts already available for the patient or with grafts of other patients with similar anatomy. Technical success was achieved in 53 cases (98%). The 30-day mortality and major stroke incidence were 5.5% (3/54) and 5.5% (3/54), respectively; in-hospital mortality was 7.4% (n = 4), and minor strokes (including asymptomatic new cerebral lesions) occurred in 5.5% (n = 3). There were two cases of transient spinal cord ischemia with complete recovery and one of paraplegia. No retrograde type A dissections or cardiac injuries were observed. Three early stent graft-related reinterventions were necessary to correct proximal endograft kinking with type IA endoleak in one patient, a bridging stent graft stenosis in another patient, and false lumen persistent perfusion from dissected supra-aortic vessels in the last patient. Mean in-hospital stay was 14 ± 8 days. During a mean follow-up of 12 ± 9 months, three nonaorta-related deaths and one aorta-related death distal to the arch repair were observed. Conclusions Treatment of aortic arch diseases with b-TEVAR is feasible and safe with acceptable mortality and stroke rates.
- Subjects :
- Adult
Male
Aortic arch
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Aorta, Thoracic
030204 cardiovascular system & hematology
Prosthesis Design
Single Center
Asymptomatic
Blood Vessel Prosthesis Implantation
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Aneurysm
Risk Factors
medicine.artery
Ascending aorta
medicine
Humans
Hospital Mortality
030212 general & internal medicine
Aged
Retrospective Studies
Aged, 80 and over
Aortic Aneurysm, Thoracic
business.industry
Endovascular Procedures
Stent
Middle Aged
medicine.disease
Blood Vessel Prosthesis
Surgery
Aortic Dissection
Dissection
Treatment Outcome
cardiovascular system
Female
Stents
medicine.symptom
Cardiology and Cardiovascular Medicine
Paraplegia
business
Subjects
Details
- ISSN :
- 07415214
- Volume :
- 69
- Database :
- OpenAIRE
- Journal :
- Journal of Vascular Surgery
- Accession number :
- edsair.doi.dedup.....a5a05ff17b97416caaf66752fd83d8b4