Endovascular Treatment of Post Type A Chronic Aortic Arch Dissection With a Branched Endograft: Early Results From a Retrospective International Multicenter Study

TY - JOUR

T1 - Endovascular Treatment of Post Type A Chronic Aortic Arch Dissection With a Branched Endograft: 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 - Aneurysm, Dissecting/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

U2 - 10.1097/SLA.0000000000003310

DO - 10.1097/SLA.0000000000003310

M3 - SCORING: Journal article

C2 - 30973389

VL - 273

SP - 997

EP - 1003

JO - ANN SURG

JF - ANN SURG

SN - 0003-4932

IS - 5

ER -