Hybrid endovascular repair for aortic arch pathology: intermediate outcomes and complications: a retrospective analysis

Woong Chol Kang, Eak Kyun Shin, Chul-Hyun Park, Jin Mo Kang, Young-Guk Ko, Donghoon Choi, Young Nam Youn, Won-Heum Shim
Catheterization and Cardiovascular Interventions 2013 August 1, 82 (2): 275-82

OBJECTIVES: To evaluate the outcomes of hybrid endovascular repair for aortic arch pathology.

METHODS: This study was a retrospective analysis involving patients who underwent hybrid endovascular repair for aortic arch pathologies.

RESULTS: Twenty-one patients (16 men; mean age, 64.7 ± 16.2 years) with aortic arch pathologies were treated by hybrid endovascular repair. The indications for treatment included increased aneurysm size in 16 cases (71.4%), rupture or impending aneurysmal rupture in 5 cases (23.8%), and rapid growth of aortic dissection (≥ 10 mm/y) in 1 case (4.8%). Supra-aortic vessel transposition and stent-graft implantation were achieved in all cases. Two types of stent-graft was used, as follows: the Seal thoracic stent-graft in 14 patients (66.7%); and the Valiant stent grafts in 7 patients (33.3%). Perioperative complications affected 5 patients (23.8%), as follows: bleeding (n = 4, 19.0%); stroke (n = 3, 14.3%); renal failure (n = 2, 9.5%); vascular injury (n = 1, 4.8%), and respiratory failure (n = 1, 4.8%). Two patients died within 30 days (9.5%). Technical success was achieved in 15 patients (71.5%). Early endoleaks were noted in 4 patients (19.0%). One patient died during follow-up (mean, 21.3 ± 11.6 months) due to a de novo intramural hematoma. Persistent early endoleaks were noted in 4 patients (19.0%); 2 of the 4 patients were successfully managed with implantation of additional stent-grafts. No late onset endoleaks were noted. The death-free survival and reintervention-free survival rates during follow-up were 85.7% and 90.5%, respectively.

CONCLUSION: Hybrid treatment with supra-aortic vessel transposition and endovascular repair may be an option in frail patients in who open procedures is too risky.

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