Abstract
The aortic arch presents specific challenges to endovascular repair. Hybrid repair is increasingly evolving as an alternative option for selected patients, and promising initial results have been reported. The aim of this study was to introduce our experiences and evaluate mid-term results of supra aortic transpositions for extended endovascular repair of aortic arch pathologies. From December 2002 to January 2008, 25 patients with thoracic aortic aneurysms and dissections involving the aortic arch were treated with hybrid endovascular treatment in our center. Of the 25 cases, 14 were atherosclerotic thoracic aortic aneurysms and 11 were thoracic aortic dissection. The hybrid repair method included total-arch transpositions (15 cases) or hemi-arch transpositions (10 cases), and endovascular procedures. All hybrid endovascular procedures were completed successfully. Three early residual type-I endoleaks and one type-II endoleak were observed. Stroke occurred in three patients (8%) during the in-hospital stage. The perioperative mortality rate was 4%; one patients died post-operatively from catheter related complications. The average follow-up period was 15 ± 5.8 months (range, 1–41 months). The overall crude survival rate at 15 months was 92% (23/25). During follow-up, new late endoleaks and stent-raft related complications were not observed. One case (4%) developed a unilateral lower limb deficit at 17 days and was readmitted to hospital. In conclusion, the results are encouraging for endovascular aortic arch repair in combination with supra-aortic transposition in high risk cases. Aortic endografting offers good mid-term results. Mid-term results of the hybrid approach in elderly patients with aortic arch pathologies are satisfying.
Highlights
The conventional surgical repair of thoracic aortic aneurysms and dissections remains a high risk procedure [1,2]
The introduction of endovascular stent graft technology has reached an evolutionary threshold for the treatment of complex aortic diseases
Hybrid repair, which constitutes a combination of open supra-aortic branch revascularization and endovascular aortic repair, has increasingly evolved as an alternative option for selected patients, and promising initial results have been reported [14,15,16,17,18]
Summary
The conventional surgical repair of thoracic aortic aneurysms and dissections remains a high risk procedure [1,2]. Based on the eight largest recent researches published (with over 40 patients) [3,4,5,6,7,8,9,10], the 30-day stroke/death rate after aortic arch surgical repair is up to 25.6% (mean 17.5%). The aortic arch presents specific challenges to endovascular repair, which mainly arise from the involvement of the supra-aortic branches and the tight inner curve. Hybrid repair, which constitutes a combination of open supra-aortic branch revascularization and endovascular aortic repair, has increasingly evolved as an alternative option for selected patients, and promising initial results have been reported [14,15,16,17,18]. The aim of this study was to introduce our expriences and evaluate mid-term results of supra aortic transpositions for extended endovascular repair of aortic arch pathologies
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