Mid-Term Results of Total Endovascular Arch Repair Using Inner Branch Devices

Abstract

Introduction - To evaluate aortic arch endovascular repair using inner branched endografts (1). Methods - 32 consecutive patients were enrolled from October 2010 to April 2017. All patients were unfit for open surgery (2,3). Results - The age of the cohort was 69 years (37-84) (27 men). Dissection (19) was the most common pathology (aneurysm 12, penetrating ulcer 1). Fifteen patients had disease in arch zone 0, 6 in zone 1, and 11 in zone 2. Twenty-seven patients had undergone prior aortic surgery (18 ascending aorta). The average number of branches per device was 2 (1-3). Twenty-four patients had surgical revascularization of the left subclavian artery and 2 of the right subclavian artery. Technical success was achieved in 29/32 cases with a procedure time of 240.6 minutes and an X-ray time of 34 minutes. One patient suffered a transient ischaemic attack, one a stroke, one transient spinal cord ischaemia and 2 required temporary dialysis. The average length of stay in intensive care and hospital were 3.4 and 14.1 days respectively. Five patients had endoleak (1a:1, II:4). The median follow-up was 16 (0-72) months during which time 12 patients required secondary procedures, 6 within 30-days. There were 3 in-hospital deaths and 6 during follow-up (none of which were aortic related). In patients that had undergone previous open ascending aortic repair (18/32) there was no incidence of in-hospital death, stroke or spinal cord ischaemia and one transient ischaemic attack. Conclusion - Aortic arch branched endografting is an important treatment option for patients unfit for open surgery. Careful selection of patients is paramount and patients with previous ascending open aortic surgery may represent the best candidates for this type of repair.