Two-Stage Open Ascending Aorta Replacement Followed by Total Aortic Arch Repair Using a Double-Fenestrated Physician-Modified Endograft for Patients with an Aortic Arch Aneurysm and an Aneurysmal Ascending Aorta.

BACKGROUND

The aim of this study is to report the feasibility and outcomes of a two-stage open ascending aorta replacement followed by total aortic arch repair using a double-fenestrated physician-modified endograft for aortic arch and ascending aorta aneurysm.

METHODS

All consecutive patients presenting with an aortic arch aneurysm and treated between 2020 and 2024 were reviewed. Inclusion criteria included arch aneurysm with aneurysmal ascending aorta compromising the proximal landing zone. Study endpoints were technical success, 30-day outcomes, and mid-term follow-up analysis of mortality, morbidity, and reinterventions.

RESULTS

Ten patients met the inclusion criteria. The median age was 68.5 years. Half had post-type B dissections, half had degenerative aneurysms. No patients died or experienced a stroke following open repair. All patients successfully underwent both procedures. The median interval between the two surgeries was 70 days. Technical success of the endovascular procedure was 100%. One patient required early reintervention after open surgery for hemostasis, and another required reintervention after the endovascular procedure for a false aneurysm at the brachial puncture site. One patient experienced a regressive stroke on postdischarge day 10 due to a sylvian artery occlusion. During mid-term follow-up, no patient died from aortic-related causes. One patient required a left subclavian artery stent extension for a type 1c endoleak 2 years after the procedure. No patients exhibited impaired renal function.

CONCLUSION

Two-staged open ascending aortic repair followed by endovascular arch repair using a double-fenestrated physician-modified endograft is a feasible, safe, and promising option that avoids the need for circulatory arrest.