Dorian Verscheure1, Stéphan Haulon1, Nikolaos Tsilimparis2, Timothy Resch3, Anders Wanhainen4, Kevin Mani4, Nuno Dias3, Jonathan Sobocinski5, Matthew Eagleton6, Marcelo Ferreira7, Geert Willem Schurink8, Bijan Modarai9, Said Abisi9, Piotr Kasprzak10, Donald Adam11, Stephen Cheng12, Blandine Maurel13, Thomasz Jakimowicz14, Amelia Claire Watkins15, Björn Sonesson3, Martin Claridge11, Dominique Fabre1, Tilo Kölbel2. 1. Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France. 2. German Aortic Center, Department of Vascular Medicine, University Heart Center Hamburg, Hamburg, Germany. 3. Skåne University Hospital, Vascular Center Malmö, Malmo, Sweden. 4. Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden. 5. CHU Lille, Department of Vascular Surgery, Lille, France. 6. Massachusetts General Hospital, Division of Vascular and Endovascular Surgery, Boston, MA. 7. Casa de Saúde São José Serviço Integrado de Técnicas Endovasculares, Department of Vascular Surgery, Rio de Janeiro, Brazil. 8. Maastricht University Medical Center, Department of Vascular Surgery, Maastricht, The Netherlands. 9. Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Department of Vascular Surgery, London, United Kingdom. 10. Department of Vascular Surgery, University of Regensburg, Regensburg, Germany. 11. University Hospitals Birmingham, NHS Foundation Trust, Birmingham, United Kingdom. 12. Department of Surgery, University of Hong Kong, Hong Kong. 13. CHU Nantes l'institut du Thorax, Service de Chirurgie Vasculaire, Nantes, France. 14. Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warszawa, Poland. 15. Stanford University School of Medicine, Department of Cardiothoracic Surgery, Stanford, CA.
Abstract
OBJECTIVE: The objective of this study was to evaluate the outcome of endovascular aortic arch repair for chronic dissection with a custom-made branched endograft. BACKGROUND: Acute type A aortic dissections are often treated with prosthetic replacement of the ascending aorta. During follow-up, repair of an aneurysmal evolution of the false lumen distal to the ascending prosthesis can be a challenge both for the surgeon and the patient. METHODS: We conducted a multicenter, retrospective study of consecutive patients from 14 vascular units treated with a custom-made, inner-branched device (Cook Medical, Bloomington, IN) for chronic aortic arch dissection. Rates of in-hospital mortality and stroke, technical success, early and late complications, reinterventions, and mortality during follow-up were evaluated. RESULTS: Seventy consecutive patients were treated between 2011 and 2018. All patients were considered unfit for conventional surgery. In-hospital combined mortality and stroke rate was 4% (n = 3), including 1 minor stroke, 1 major stroke causing death, and 1 death following multiorgan failure. Technical success rate was 94.3%. Twelve (17.1%) patients required early reinterventions: 8 for vascular access complication, 2 for endoleak correction, and 2 for pericardial effusion drainage. Median follow-up was 301 (138-642) days. During follow-up, 20 (29%) patients underwent secondary interventions: 9 endoleak corrections, 1 open repair for prosthetic kink, and 10 distal extensions of the graft to the thoracic or thoracoabdominal aorta. Eight patients (11%) died during follow-up because of nonaortic-related cause in 7 cases. CONCLUSIONS: Endovascular treatment of aortic arch chronic dissections with a branched endograft is associated with low mortality and stroke rates but has a high reintervention rate. Further follow-up is required to confirm the benefits of this novel approach.
OBJECTIVE: The objective of this study was to evaluate the outcome of endovascular aortic arch repair for chronic dissection with a custom-made branched endograft. BACKGROUND: Acute type A aortic dissections are often treated with prosthetic replacement of the ascending aorta. During follow-up, repair of an aneurysmal evolution of the false lumen distal to the ascending prosthesis can be a challenge both for the surgeon and the patient. METHODS: We conducted a multicenter, retrospective study of consecutive patients from 14 vascular units treated with a custom-made, inner-branched device (Cook Medical, Bloomington, IN) for chronic aortic arch dissection. Rates of in-hospital mortality and stroke, technical success, early and late complications, reinterventions, and mortality during follow-up were evaluated. RESULTS: Seventy consecutive patients were treated between 2011 and 2018. All patients were considered unfit for conventional surgery. In-hospital combined mortality and stroke rate was 4% (n = 3), including 1 minor stroke, 1 major stroke causing death, and 1 death following multiorgan failure. Technical success rate was 94.3%. Twelve (17.1%) patients required early reinterventions: 8 for vascular access complication, 2 for endoleak correction, and 2 for pericardial effusion drainage. Median follow-up was 301 (138-642) days. During follow-up, 20 (29%) patients underwent secondary interventions: 9 endoleak corrections, 1 open repair for prosthetic kink, and 10 distal extensions of the graft to the thoracic or thoracoabdominal aorta. Eight patients (11%) died during follow-up because of nonaortic-related cause in 7 cases. CONCLUSIONS: Endovascular treatment of aortic arch chronic dissections with a branched endograft is associated with low mortality and stroke rates but has a high reintervention rate. Further follow-up is required to confirm the benefits of this novel approach.
Authors: Alice Finotello; Bianca Pane; Mauro Di Bartolo; Rachele Del Pizzo; Simone Mambrini; Giovanni Pratesi; Giovanni Spinella Journal: Aorta (Stamford) Date: 2022-08-07