Branch stent-grafting for endovascular repair of chronic aortic arch dissection

Abstract

Background: The preliminary clinical outcomes of a novel branch stent-grafting for endovascular repair of chronic aortic arch dissection proved its safety and effectiveness.

Objective: The purpose of this study is to present the long-term outcomes and evaluate the durability of this novel endovascular therapy.

Methods: Between August 2009 and January 2014, 51 patients with aortic dissections involving arch branches were treated by the endovascular stent-grafting. There were 7 Stanford type A aortic dissections, 22 retrograde type A aortic dissections, and 22 Stanford type B aortic dissections. The supra-arch branch arteries were reconstructed by individualized strategies.

Results: All the proximal entry tears in arch were successfully excluded, and no type I/III endoleaks occurred. The median follow-up period was 92 months (range, 62-114 months). A total of 7 complications, 4 deaths, and 3 reinterventions occurred. There were 2 deaths from retrograde type A aortic dissections, 1 death from cerebral infarction, and 1 death from malignant tumor. The incidence of complications, reintervention, all-cause mortality, and aorta-related mortality was 0.035%/patient-year, 0.015%/patient-year, 0.020%/patient-year, and 0.010%/patient-year, respectively. The patency rate of cervical bypass was 90.1%. The significant true lumen recovery and false lumen shrinkage were observed at the 4 designated levels of the thoracic aorta according to computed tomography angiography images.

Conclusions: Based on preoperatively adequate planning and accurate measurement, endovascular repair of chronic aortic arch dissection using this branched stent-graft showed a low and an acceptable incidence of complications and mortality with positive aortic remodeling, which provided a satisfactory and promising alternative treatment option.

Keywords: aortic arch dissection; branch stent-grafting; endovascular repair; long-term follow-up.