Midterm Results of Surgical Debranching for Aortic Arch Endovascular Repair.

BACKGROUND

To evaluate the outcomes of surgical debranching of supra-aortic trunks (dSAT) for the endovascular treatment of aortic arch pathologies.

METHODS

Single-center retrospective analysis (2014-2024) of patients undergoing dSAT associated with endovascular treatment involving thoracic endovascular aortic repair in the aortic arch was performed. Primary end points were defined on dSAT and secondary end points on patients. Subgroup analyses considered dSAT combined versus analyses deferred to endovascular procedure. Cross-table analysis was performed for categorial variables and Kaplan-Meier for follow-up analysis.

RESULTS

Eighty-two patients (mean age: 71, 78% male) were included. Pathologies included aortic arch (24%) and thoracic/thoracoabdominal (76%) diseases. A total of 87 dSAT were performed: a left common carotid artery (LCCA)-left subclavian artery (LSA) bypass in 57 (70%) cases, a right-common carotid artery to LSA with reimplant of LCCA in 18 (22%), bilateral carotid-subclavian bypasses in five (6%), 2 (2%) direct reimplants (LCCA; vertebral artery). Seventy patients (85%) had a single and 12 patients (15%) had a deferred endovascular repair. Technical success was 100%. Thirty days dSAT related reinterventions were 7 (8%) (one arterial dissection and six bleedings). Nonsurgical dSAT complications were 4 (5%) (three left vocal cord paralysis; one chylothorax). Thirty-day mortality was 8% (7 patients), unrelated to dSAT. No cases of stroke were reported. Subgroup analysis showed absence of debranching related complications/reinterventions in deferred group. The median follow-up was 20 months (interquartile range: 10-37). Follow-up debranching primary patency was 100% without reinterventions.

CONCLUSION

The dSAT is a safe and effective procedure for endovascular treatment of aortic pathologies involving the aortic arch. Patency is high and reinterventions/complications are mainly linked to bleedings and seem to have a positive trend when endovascular procedure is performed in deferred stage.