• Dorian Verscheure, Stéphan Haulon, Nikolaos Tsilimparis, Timothy Resch, Anders Wanhainen, Kevin Mani, Nuno Dias, Jonathan Sobocinski, Matthew Eagleton, Marcelo Ferreira, Geert Willem Schurink, Bijan Modarai, Said Abisi, Piotr Kasprzak, Donald Adam, Stephen Cheng, Blandine Maurel, Thomasz Jakimowicz, Amelia Claire Watkins, Björn Sonesson, Martin Claridge, Dominique Fabre, and Tilo Kölbel.
• Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France.
• Ann. Surg. 2021 May 1; 273 (5): 9971003997-1003.

ObjectiveThe objective of this study was to evaluate the outcome of endovascular aortic arch repair for chronic dissection with a custom-made branched endograft.BackgroundAcute type A aortic dissections are often treated with prosthetic replacement of the ascending aorta. During follow-up, repair of an aneurysmal evolution of the false lumen distal to the ascending prosthesis can be a challenge both for the surgeon and the patient.MethodsWe conducted a multicenter, retrospective study of consecutive patients from 14 vascular units treated with a custom-made, inner-branched device (Cook Medical, Bloomington, IN) for chronic aortic arch dissection. Rates of in-hospital mortality and stroke, technical success, early and late complications, reinterventions, and mortality during follow-up were evaluated.ResultsSeventy consecutive patients were treated between 2011 and 2018. All patients were considered unfit for conventional surgery. In-hospital combined mortality and stroke rate was 4% (n = 3), including 1 minor stroke, 1 major stroke causing death, and 1 death following multiorgan failure. Technical success rate was 94.3%. Twelve (17.1%) patients required early reinterventions: 8 for vascular access complication, 2 for endoleak correction, and 2 for pericardial effusion drainage. Median follow-up was 301 (138-642) days. During follow-up, 20 (29%) patients underwent secondary interventions: 9 endoleak corrections, 1 open repair for prosthetic kink, and 10 distal extensions of the graft to the thoracic or thoracoabdominal aorta. Eight patients (11%) died during follow-up because of nonaortic-related cause in 7 cases.ConclusionsEndovascular treatment of aortic arch chronic dissections with a branched endograft is associated with low mortality and stroke rates but has a high reintervention rate. Further follow-up is required to confirm the benefits of this novel approach.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

34 keywords...

hide…