Endovascular repair for thoracic aortic arch aneurysms

• Published in: International angiology Vol. 25; no. 3; pp. 249 - 255
• Main Authors: CARONNO, R, PIFFARETTI, G, TOZZI, M, LOMAZZI, C, CUFFARI, S, SALA, A, CASTELLI, P
• Format: Journal Article
• Language: English
• Published: Torino Minerva Medica 01.09.2006; Edizioni Minerva Medica
• Subjects: Aged; Aged, 80 and over; Analysis of Variance; Aneurysm, Dissecting - pathology; Aneurysm, Dissecting - surgery; Angioplasty - methods; Aortic Aneurysm, Thoracic - pathology; Aortic Aneurysm, Thoracic - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation; Cardiology. Vascular system; Cardiovascular system; Carotid Artery, Common - surgery; Cause of Death; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; Hospital Mortality; Humans; Investigative techniques, diagnostic techniques (general aspects); Italy - epidemiology; Male; Medical sciences; Middle Aged; Postoperative Complications - etiology; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Reoperation; Retrospective Studies; Stents; Subclavian Artery - surgery; Survival Rate; Time Factors; Treatment Outcome; Ultrasonic investigative techniques; Vascular Patency; Italy; Aortic arch, thoracic; Aortic aneurysms, thoracic; Aortic arch; Cardiovascular disease; Endovascular route; Aortic aneurysm; Stent; Grafting; Stents
• ISSN: 0392-9590; 1827-1839

The aim of this study was to report our experience with total and subtotal endovascular stent-grafting combined with aortic arch branch surgical revascularization for thoracic aortic arch aneurysms in high-risk patients. From December 2000 to June 2005, among 38 patients treated with thoracic stent-grafts in our department, 10 patients (9 men; mean age 71+/-6 years) at high risk for open repair were candidates for endovascular repair and/or aortic arch branch extra-anatomical reconstruction due to inadequate proximal landing zones. The left subclavian artery was over-stented 6 cases for zone 2 aneurysms, and partial or total arch stent-grafting with simultaneous revascularization of the arch branches was performed in 4 cases for zones 0-1 aneurysms. Primary technical success rate was 100%. In-hospital mortality rate was 10%. Neither paraplegia, nor acute renal failure were recorded. Immediate or late surgical conversion was never required. One type 1b was successfully treated with additional stent-graft and 2 type-2 endoleaks were sealed by coil embolization. Mean follow-up was 21-months (range 3-48 months); overall, survival rate at 12, 26, and 36 months was 90%, 60%, and 30%, respectively. Endovascular repair for thoracic aortic arch aneurysms is feasible. However, our experience suggests stent-grafting is not free of risk, and long-term and larger follow-up is required.