Endovascular Aortic Arch Repair with Prosthetic Landing Zone in Stanford Type A Aortic Dissection

Abstract

Introduction - Endovascular aortic arch repair is an emerging intervention for the treatment of aortic arch diseases. We report the outcomes from a prospective registry study of endovascular aortic arch repair with prosthetic landing zone for Stanford type A aortic dissection. Methods - All endovascular aortic arch repair with prosthetic landing zone for Stanford type A aortic dissection performed between November 2009 and November 2016 were prospectively included in the single center registry study. The primary outcome was death from any causes. Results - A total of 140 patients who were confirmed with Stanford type A aortic dissection involving aortic arch by CTA on admission were enrolled. The mean (±SD) age was 61.8±7.3 years; 35.7% of the patients were women. Either ascending graft branch approach (18.6%) or femoral artery approach (81.4%) was applied for delivery of endovascular grafts into aortic arch. The incidence of death at 30 days and 1 year were 6.4% and 10.3%, respectively. The incidence of radiological diagnosis of stroke and endoleak at 30 days were 3.6% and 7.1%. In multivariate models, patient age (≥60) was associated with reduced survival and antegrade deployment of endovascular graft through ascending graft branch was associated with increased risk of endoleak. Conclusion - The results of this registry study revealed the clinical experience of endovascular aortic arch repair with prosthetic landing zone in patients with Stanford type A aortic dissection, in whom utilizing Dacron graft in ascending aorta as prosthetic landing zone for endovascular arch repair appeared to be a reasonable option with favorable clinical outcome and false lumen remodeling in aortic arch.