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

Verscheure, Dorian and Haulon, Stéphan and Tsilimparis, Nikolaos and Resch, Timothy and Wanhainen, Anders and Mani, Kevin and Dias, Nuno and Sobocinski, Jonathan and Eagleton, Matthew and Ferreira, Marcelo and Schurink, Geert Willem and Modarai, Bijan and Abisi, Said and Kasprzak, Piotr and Adam, Donald and Cheng, Stephen and Maurel, Blandine and Jakimowicz, Thomasz and Watkins, Amelia Claire and Sonesson, Björn and Claridge, Martin and Fabre, Dominique and Kölbel, Tilo (2019) Endovascular Treatment of Post Type A Chronic Aortic Arch Dissection With a Branched Endograft: Early Results From a Retrospective International Multicenter Study. Annals of surgery. ISSN 1528-1140. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Abstract

MINI: The objective of this study was to evaluate the outcome of endovascular repair of chronic aortic arch dissecting aneurysms with a custom-made branched endograft during follow-up after acute type A aortic dissection open repair. Unmatched outcomes are reported in a population at high risk for a redo sternotomy.

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.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WG Cardiovascular system. Cardiology
Divisions: Planned IP Care > General Surgery
Planned IP Care > Vascular
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Depositing User: Mrs Yolande Brookes
Date Deposited: 12 Apr 2019 11:55
Last Modified: 12 Apr 2019 11:55
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/2013

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