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Multicenter Study
. 2023 Dec;46(12):1674-1683.
doi: 10.1007/s00270-023-03607-7. Epub 2023 Nov 17.

Multicenter Comparison of Aortic Arch Aneurysms and Dissections Zone 0 Hybrid and Total Endovascular Repair

Edoardo Frola  1 , Lorenzo Mortola  2 , Emanuele Ferrero  3 , Michelangelo Ferri  3 , Dimitrios Apostolou  2 , Simone Quaglino  3 , Massimo Maione  2 , Andrea Gaggiano  3
Affiliations
Multicenter Study

Multicenter Comparison of Aortic Arch Aneurysms and Dissections Zone 0 Hybrid and Total Endovascular Repair

Edoardo Frola et al. Cardiovasc Intervent Radiol. 2023 Dec.

Abstract

Purpose: Comparison of hybrid and total endovascular aortic arch repair at two tertiary vascular surgery centers.

Materials and methods: Consecutive patients undergoing hybrid (HG) or total endovascular (TEG) total aortic arch repair for aneurysms or dissections were included (2008-2022). Primary outcome measure was 30-day mortality. Secondary outcomes were major complications, technical success (defined as absence of surgical conversion/mortality, high-flow endoleaks or branch/limb occlusion), clinical success (defined as absence of disabling clinical sequelae), late and aortic-related mortality/reinterventions, freedom from endoleaks, aortic diameter growth > 5 mm, graft migration and supra-aortic trunks (SAT) patency.

Results: In total, 30 patients were included, 17 in HG and 13 in TEG. TEG presented shorter intervention time (240.5 vs 341 min, p = 0.01), median ICU stay (1 vs 4.5 days, p < 0.01) and median length of stay (8 vs 17.5 days, p < 0.01). No intraoperative deaths occurred. Technical success was 100%; clinical success was 70.6% in HG and 100% in TEG (p = 0.05). Thirty-day mortality was 13.3%, exclusively in HG (p = 0.11). Nine major complications occurred in 8 patients, 5 in HG and 3 in TEG (p = 0.99), among which five strokes, two in HG and three in TEG (p = 0.62). Late mortality was 38.5%, six patients in HG and four in TEG, p = 0.6. Two late aortic-related deaths occurred in HG (p = 0.9). Two aortic-related reinterventions, no graft migration or SAT occlusion was observed.

Conclusions: Total endovascular repair seems to shorten operative times and provide higher clinical success compared with hybrid solutions, without significant 30-day mortality differences. The most common major complication is stroke.

Keywords: Aortic arch; Debranching; Hybrid repair; Total endovascular repair.

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