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. 2021 May 1;273(5):997-1003.
doi: 10.1097/SLA.0000000000003310.

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

Dorian Verscheure  1 , Stéphan Haulon  1 , Nikolaos Tsilimparis  2 , Timothy Resch  3 , Anders Wanhainen  4 , Kevin Mani  4 , Nuno Dias  3 , Jonathan Sobocinski  5 , Matthew Eagleton  6 , Marcelo Ferreira  7 , Geert Willem Schurink  8 , Bijan Modarai  9 , Said Abisi  9 , Piotr Kasprzak  10 , Donald Adam  11 , Stephen Cheng  12 , Blandine Maurel  13 , Thomasz Jakimowicz  14 , Amelia Claire Watkins  15 , Björn Sonesson  3 , Martin Claridge  11 , Dominique Fabre  1 , Tilo Kölbel  2
Affiliations

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

Dorian Verscheure et al. Ann Surg. .

Abstract

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.

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Conflict of interest statement

The authors report no conflicts of interest.

References

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