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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
ORIGINAL ARTICLES SELECTED PAPERS FROM SICVE NATIONAL CONGRESS 2009
Italian Journal of Vascular and Endovascular Surgery 2010 September;17(3):177-87
Midterm results of endovascular treatment of aortic arch
Bertoglio L., Civilini E., Marone E. M., Tshomba Y., Melissano G., Chiesa R.
Department of Vascular Surgery Vita – Salute University, Scientific Institute San Raffaele Hospital, Milan, Italy
Aim. Hybrid repair of aortic arch pathologies consisting in supra-aortic trunks re-routing and arch endograft exclusion, has been shown, in selected patients, to be a feasible and attractive alternative to the conventional open surgery. The aim of this study was to compare the technical and clinical outcomes recorded in the different anatomical settings of endografting for aortic arch disease.
Methods. Between January 1999 and October 2008, 292 patients were treated for diseases of thoracic aorta with stent-graft at our Institution; the aortic arch was involved in 106 cases (92 males, mean age 70.6±10.7. Patients were divided into 3 groups according to Ishimaru’s classification, zone “0” 22 cases, zone “1” 23 cases, zone “2”: 61 cases. Seventy cases were treated with an hybrid approach that consisted in supraortic vessels debranching and successive endovascular exclusion of the aortic arch pathology.
Results. Zone “0”: proximal neck length after debranching was 43.9±5.6 mm. Initial clinical success 82%: 3 deaths (stroke), 1 type Ia endoleak. At a mean follow-up of 24.7±17 months the midterm clinical success was 86%. Zone “1”: proximal neck length: 29±5 mm. Initial clinical success 83%: 0 deaths, 4 type Ia endoleaks. At a mean follow-up of 20.1±16 months the midterm clinical success was 91%. Zone “2”: proximal neck length after debranching was 30.4±5.0 mm, clinical success was 90.2%: 1 death, 4 type I endoleaks. At a mean follow-up of 33.4±19.2 months the midterm clinical success was 95.1%: 3 type I endoleak spontaneous resolutions, 1 conversion.
Conclusions. Hybrid treatment of aortic arch pathologies is technically feasible with reasonable morbidity and mortality rates at short and midterm follow-up. Total de-branching of the arch for “zone 0” aneurysms allowed to obtain a longer proximal aortic landing zone with lower incidence of endoleak, however a higher risk of cerebrovascular accident was observed. The relatively high incidence of adverse events in “zone 1” could be associated to a shorter proximal neck, therefore this landing zone is reserved for patients unfit for sternotomy.