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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2018 Jan 19

DOI: 10.23736/S0021-9509.18.10412-5


language: English

Total endovascular arch repair is the procedure of the future. Part I

Konstantinos SPANOS , Nikolaos TSILIMPARIS, Fiona ROHLFFS, Sabine WIPPER, Christian DETTER, Christian-Alexander BEHRENDT, Sebastian E. DEBUS, Tilo KÖLBEL

Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, Hamburg, Germany


BACKGROUND: This study evaluates the current experience on endovascular repair of the aortic arch pathologies, the feasibility and safety of the procedure.
EVIDENCE ACQUISITION: A systematic review was performed. MEDLINE, CENTRAL, and Cochrane databases were searched with PRISMA methodology for published studies reporting on endovascular repair of aortic arch pathologies from 2000 to 2018.
EVIDENCE SYNTHESIS: Thirteen non-randomized retrospective studies (either single or multicenter), two multicenter Registries and one multicenter non-randomized interventional study were included in the systematic review. The total number of patients who underwent total endovascular repair of the aortic arch pathology with either fenestrated, branched, or a combination of those devices or chimney technique was 952 patients (73%; 634/872 males, mean age ranging from 51 to 78 years). The technical success rate was 96.7% (921/952), while the 30-day mortality rate was 3.3% (32/952). The most common adverse events were endoleak type I (13.5%; 35/259), stroke (5.1%; 49/952), spinal cord ischemia (1.4%; 14/952) and retrograde dissection (1%; 8/952). During the follow up period (mean ranging: 16.9 to 41.4 months; median ranging: 9 to 44.8 months) the total number of deaths was 31 (4.4%; 31/693). The total loss of supra-aortic vessel patency rate was 1.7% (14/803) and a re-intervention was needed in 50 patients (9%; 50/559; 11 open conversion).
CONCLUSIONS: Endovascular repair of aortic arch pathologies is a feasible treatment option with good early and reasonable mid-term outcomes. This treatment modality approaches a level of maturity and may be considered as a solid alternative method of treatment.

KEY WORDS: Endovascular repair - Aortic arch - Hybrid procedure - Supra-aortic arteries

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Publication History

Article first published online: January 19, 2018
Manuscript accepted: January 16, 2018
Manuscript received: January 14, 2018

Cite this article as

Spanos K, Tsilimparis N, Rohlffs F, Wipper S, Detter C, Behrendt CA, et al. Total endovascular arch repair is the procedure of the future. Part I. J Cardiovasc Surg 2018 Jan 19. DOI: 10.23736/S0021-9509.18.10412-5

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