Abstract

IntroductionConventional techniques of surgical correction of arch and descending aortic diseases remains as high-risk procedures. Endovascular treatments of abdominal and descending thoracic aorta have lower surgical risk. Evolution of both techniques - open debranching of the arch and endovascular approach of the descending aorta - may extend a less invasive endovascular treatment for a more extensive disease with necessity of proximal landing zone in the arch.ObjectiveTo evaluate descending thoracic aortic remodeling by means of volumetric analysis after hybrid approach of aortic arch debranching and stenting the descending aorta.MethodsRetrospective review of seven consecutive patients treated between September 2014 and August 2016 for diseases of proximal descending aorta (aneurysms and dissections) by hybrid approach to deliver the endograft at zone 1. Computed tomography angiography were analyzed using a specific software to calculate descending thoracic aorta volumes pre- and postoperatively.ResultsFollow-up was done in 100% of patients with a median time of 321 days (range, 41-625 days). No deaths or permanent neurological complications were observed. There were no endoleaks or stent migrations. Freedom from reintervention was 100% at 300 days and 66% at 600 days. Median volume reduction was of 45.5 cm3, representing a median volume shrinkage by 9.3%.ConclusionHybrid approach of arch and descending thoracic aorta diseases is feasible and leads to a favorable aortic remodeling with significant volume reduction.

Highlights

  • Conventional techniques of surgical correction of arch and descending aortic diseases remains as high-risk procedures

  • Endovascular treatments of abdominal and thoracic descending aorta are already well-established and have a lower surgical risk when compared to conventional techniques[2]

  • The purpose of this study is to evaluate the aortic remodeling after hybrid approach of the distal arch and proximal descending aortic diseases by means of volumetric analysis of the descending thoracic aorta

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Summary

Introduction

Conventional techniques of surgical correction of arch and descending aortic diseases remains as high-risk procedures. Conventional techniques for surgical correction of aortic arch and descending diseases (either aneurysms or dissections) requires extracorporeal circulation associated with deep hypothermia and circulatory arrest. It remains as highrisk procedures, recent advances (pre-, intra- and postoperatively) have improved results dramatically[1]. Debranching of supra-aortic vessels enables access to healthier aortic sections, propitious to serve as landing zones to endovascular prosthesis[3,4]. This hybrid aortic arch approach has emerged as a less invasive option, mainly to high-risk patients[5,6]

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