TY - JOUR
T1 - Endovascular Treatment of Post Type A Chronic Aortic Arch Dissection With a Branched Endograft
T2 - Early Results From a Retrospective International Multicenter Study
AU - Verscheure, Dorian
AU - Haulon, Stéphan
AU - Tsilimparis, Nikolaos
AU - Resch, Timothy
AU - Wanhainen, Anders
AU - Mani, Kevin
AU - Dias, Nuno
AU - Sobocinski, Jonathan
AU - Eagleton, Matthew
AU - Ferreira, Marcelo
AU - Schurink, Geert Willem
AU - Modarai, Bijan
AU - Abisi, Said
AU - Kasprzak, Piotr
AU - Adam, Donald
AU - Cheng, Stephen
AU - Maurel, Blandine
AU - Jakimowicz, Thomasz
AU - Watkins, Amelia Claire
AU - Sonesson, Björn
AU - Claridge, Martin
AU - Fabre, Dominique
AU - Kölbel, Tilo
N1 - Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/5/1
Y1 - 2021/5/1
N2 - 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.
AB - 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.
KW - Aortic Dissection/diagnosis
KW - Aorta, Thoracic/diagnostic imaging
KW - Aortic Aneurysm, Thoracic/diagnosis
KW - Blood Vessel Prosthesis Implantation/methods
KW - Chronic Disease
KW - Computed Tomography Angiography
KW - Endovascular Procedures/methods
KW - Female
KW - Follow-Up Studies
KW - Global Health
KW - Hospital Mortality/trends
KW - Humans
KW - Male
KW - Middle Aged
KW - Prosthesis Design
KW - Retrospective Studies
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85072696880&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000003310
DO - 10.1097/SLA.0000000000003310
M3 - Journal article
C2 - 30973389
SN - 0003-4932
VL - 273
SP - 997
EP - 1003
JO - Annals of Surgery
JF - Annals of Surgery
IS - 5
ER -