TY - JOUR
T1 - Aortic Arch Debranching and Thoracic Endovascular Aortic Repair (TEVAR) for Type B Aortic Dissection
AU - Bashir, Mohamad
AU - Jubouri, Matti
AU - Surkhi, Abdelaziz O.
AU - Sadeghipour, Parham
AU - Pouraliakbar, Hamidreza
AU - Rabiee, Parham
AU - Jolfayi, Amir Ghaffari
AU - Mohebbi, Bahram
AU - Moosavi, Jamal
AU - Babaei, Mohammadreza
AU - Afrooghe, Arya
AU - Ghoorchian, Ehsan
AU - Awad, Wael I.
AU - Velayudhan, Bashi
AU - Mohammed, Idhrees
AU - Bailey, Damian M.
AU - Williams, Ian M.
N1 - Funding Information:
Conflict of interest (COI) and funding: D.M. Bailey is a Royal Society Wolfson Research Fellow (#WM170007); otherwise, there is no COI or funding.
Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2024/2
Y1 - 2024/2
N2 - BACKGROUND: Since its introduction, thoracic endovascular aortic repair (TEVAR) has revolutionized the treatment of type B aortic dissections (TBADs). However, the proximal aspect of the aortic pathology treated may infringe on the origin of the left subclavian artery or even more proximally. Hence, to ensure durable outcomes, the origin of these vessels needs to be covered, but an extra-anatomical bypass is required to perfuse vital branches, known as aortic arch debranching. This series aims to describe and delineate the disparities of aortic arch debranching during TEVAR for TBAD.METHODS: A retrospective review and analysis of a multicenter international database was conducted to identify patients with TBAD treated with TEVAR between 2005 and 2021. Data analyzed included patient demographics, disease characteristics, operative characteristics, and postoperative outcomes with follow-up on mortality and reintervention. All statistical analyses were carried out using IBM SPSS 26. Patient survival was calculated using a Kaplan-Meier survival analysis, and a P value of less than 0.05 was considered statistically significant.RESULTS: A total of 58 patients were included in the analysis, of which 27 (46.6%) presented with complicated disease and 31 were uncomplicated, of which 10 (17.2%) were classed as high risk and 21 (36.2%) low risk. Zone 2 was the most common proximal landing zone for the stent graft. Left subclavian artery bypass was performed selectively (26%), with 1 stroke occurring, likely due to embolic reasons. A further 6 underwent more proximal aortic debranching before TEVAR (10%) and was a significant risk factor for mortality and the number of stents deployed. The overall rates of reintervention and mortality were 17.2% (n = 10) and 29.3% (n = 17).CONCLUSIONS: Aortic arch debranching and TEVAR for TBAD is associated with significant mortality. Future developments to treat aortic arch pathology could incorporate branched graft devices, eliminating the need for debranching, improving stroke rates, and reducing future reinterventions.
AB - BACKGROUND: Since its introduction, thoracic endovascular aortic repair (TEVAR) has revolutionized the treatment of type B aortic dissections (TBADs). However, the proximal aspect of the aortic pathology treated may infringe on the origin of the left subclavian artery or even more proximally. Hence, to ensure durable outcomes, the origin of these vessels needs to be covered, but an extra-anatomical bypass is required to perfuse vital branches, known as aortic arch debranching. This series aims to describe and delineate the disparities of aortic arch debranching during TEVAR for TBAD.METHODS: A retrospective review and analysis of a multicenter international database was conducted to identify patients with TBAD treated with TEVAR between 2005 and 2021. Data analyzed included patient demographics, disease characteristics, operative characteristics, and postoperative outcomes with follow-up on mortality and reintervention. All statistical analyses were carried out using IBM SPSS 26. Patient survival was calculated using a Kaplan-Meier survival analysis, and a P value of less than 0.05 was considered statistically significant.RESULTS: A total of 58 patients were included in the analysis, of which 27 (46.6%) presented with complicated disease and 31 were uncomplicated, of which 10 (17.2%) were classed as high risk and 21 (36.2%) low risk. Zone 2 was the most common proximal landing zone for the stent graft. Left subclavian artery bypass was performed selectively (26%), with 1 stroke occurring, likely due to embolic reasons. A further 6 underwent more proximal aortic debranching before TEVAR (10%) and was a significant risk factor for mortality and the number of stents deployed. The overall rates of reintervention and mortality were 17.2% (n = 10) and 29.3% (n = 17).CONCLUSIONS: Aortic arch debranching and TEVAR for TBAD is associated with significant mortality. Future developments to treat aortic arch pathology could incorporate branched graft devices, eliminating the need for debranching, improving stroke rates, and reducing future reinterventions.
KW - Humans
KW - Aorta, Thoracic/diagnostic imaging
KW - Endovascular Aneurysm Repair
KW - Blood Vessel Prosthesis
KW - Blood Vessel Prosthesis Implantation
KW - Aortic Aneurysm, Thoracic/diagnostic imaging
KW - Treatment Outcome
KW - Endovascular Procedures
KW - Aortic Dissection/diagnostic imaging
KW - Stents
KW - Risk Factors
KW - Stroke
KW - Retrospective Studies
U2 - 10.1016/j.avsg.2023.08.037
DO - 10.1016/j.avsg.2023.08.037
M3 - Article
C2 - 37866676
SN - 0890-5096
VL - 99
SP - 320
EP - 331
JO - Annals of Vascular Surgery
JF - Annals of Vascular Surgery
ER -