Outcome of fenestrated and Branched Endovascular Repair of Aortic Arch Pathology

Abstract

Introduction: Operative management of aortic arch pathology remains a complex challenge and an area that poses significant obstacles to a totally endovascular approach. The aim of this study was to report the outcomes of custom-made fenestrated and branched endovascular aortic repair involving the arch (fEVARA and bEVARA) in our aortic center. Methods: All patients treated with fEVARA or bEVARA were reviewed. Indications for intervention, technical success, 30-day mortality and post-operative sequelae were examined. Results: Between May 2014 and February 2019, 24 patients underwent f/bEVARA. The mean age was 68 years (range 45-85); 9 were female. The median follow up was 16 months (range 1-59). The indications for intervention included degenerative aneurysm (n=11) and post dissection aneurysm (n=13). 4 patients had a connective tissue disorder and 11 had undergone previous open ascending aortic repair. 6 cases were part of further staged aortic intervention. Stent graft morphology included: 6 fenestrated grafts (Left Subclavian), 7 fenestration + scallop (Left Subclavian and Left Carotid artery), 1 scallop only (Left Subclavian); and 10 branched cases (Brachiocephalic, left Carotid and +/- Left Subclavian artery). The proximal landing was zone 0 (n=10), zone 1 (n=7) and zone 2 (n=7). 30-day mortality was 4% (n=1 retrograde type A dissection (RTAD) post discharge). Four non-disabling strokes and one non-fatal RTAD occurred within 30-days. Three of these patients had been treated with a fenestration and scallop combination, and both RTADs occurred in patients with fEVARA for chronic type B dissection. One additional late aortic death occurred (descending aortic rupture post-dissection aneurysm). One brachiocephalic trunk branch was relined 8 days post-op but target vessel patency remained 100%. Conclusion: f/bEVARA are feasible options for the management of aortic arch pathology with an acceptable short-term mortality. Cerebrovascular events are the main comorbidity. Peri-operative events were notably experienced in fEVARA, with grafts comprising a fenestration and scallop morphology, and also in chronic dissection cases. Disclosure: Nothing to disclose