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. 2018 May;7(3):366-371.
doi: 10.21037/acs.2018.04.08.

Endovascular arch replacement with a dual branched endoprosthesis

Ciro Ferrer  1 , Piergiorgio Cao  2
Affiliations

Endovascular arch replacement with a dual branched endoprosthesis

Ciro Ferrer et al. Ann Cardiothorac Surg. 2018 May.

Abstract

Background: In the light of current evidence, endovascular repair of aortic arch pathologies with custom-made devices should be considered a valid alternative to decrease operative mortality and morbidity associated with open or hybrid repair. Currently, two double inner branch devices are available on the market. Some papers from multicenter experiences have been published about the use of Cook device. We report our single-center experience with Bolton double branch stent graft in the treatment of aortic arch disease.

Methods: Between 2013 and 2016, nine high-risk patients with arch pathology were treated in our center with a Bolton custom-made branched device. Among these, two with a single branch model were excluded, leaving a subgroup of seven patients of this study.

Results: Out of the seven male patients (mean age, 76; range, 70-85) included in the study, two (28%) died perioperatively after stroke (14%) and retrograde dissection (14%), respectively. No other death, major complications, including aneurysmal diameter evolution and branch related complications, or secondary intervention was recorded at a mean follow up of 24 [6-53] months.

Conclusions: Despite the small sample size, our results are in line with the early experiences published on this technique. Endovascular repair of aortic arch disease with custom-made branched devices should always be considered to give high-risk patients a chance of repair.

Keywords: Aortic arch; aortic aneurysm; branched stent graft; custom-made stent graft; endovascular repair.

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Conflict of interest statement

Conflicts of Interest: C Ferrer discloses proctoring and speaker’s fees from Bolton Medical; P Cao discloses proctoring from Cook.

Figures

Figure 1
Figure 1
Bolton double branch device.
Figure 2
Figure 2
3D reconstruction of post-operative CTA after double branch arch procedure with Bolton device. LCCA-LSA bypass (arrow). CTA, computed tomographic angiography; LCCA, left common carotid artery; LSA, left subclavian artery.
Figure 3
Figure 3
Ascending aorta retrograde dissection (arrow) detected at early post-operative CTA after double branch implantation (Bolton device). CTA, computed tomographic angiography.
Figure 4
Figure 4
Partial coverage of the left vertebral artery by the vascular plug deployed in the LSA in a double branch procedure with Cook device. LSA, left subclavian artery.
See this image and copyright information in PMC

References

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