Long-Term Outcomes of Thoracic Endovascular Repair for Aortic Arch Dissection Using Customized Single-Branched Fenestrated Stent-Graft

Abstract

Objectives:

To report outcomes of thoracic endovascular repair using customized single-branched fenestrated stent-grafts in treatment of aortic arch dissections.

Materials and Methods:

Between November 2009 and November 2011, 16 patients with aortic arch dissections underwent thoracic endovascular aortic repair utilizing customized unibody single-branched fenestrated stent-graft (UBFSG) in our institution.

Results:

All 16 patients were male with mean age of 54.50 ± 11.33. The technical success rate was 100%. 30-day mortality rate was 6.25% (n = 1). The median follow-up period was 98 months (range, 0-119). During follow-up, 4 nonaorta-related deaths were recorded. Two (2) cases of left subclavian artery occlusion were observed 12 and 14 months after the operation. Two (2) patients had another successful endovascular repair in time, including one case of type Ib endoleak occurred 100 months after the operation and one case of stent-graft induced new entry tear 38 months after the operation. No stroke and migration of stent-grafts were observed.

Conclusions:

The branched fenestrated stent-graft may be an effective alternative treatment for aortic arch dissections unfit for open surgery.

Keywords

endovascular treatment thoracic aorta dissection stent-graft custom-made device

Get full access to this article

View all access options for this article.

References

Bossone

LaBounty

Eagle

. Acute aortic syndromes: diagnosis and management, an update. Eur Heart J. 2018;39(9):739d–749d.

Ahmad

Mylonas

Majd

Brunkwall

. A current systematic evaluation and meta-analysis of chimney graft technology in aortic arch diseases. J Vasc Surg. 2017;66(5):1602–1610. e2.

Bai

Liu

Jin

. Mid-term results of in situ fenestration stented with balloon-expandable bare metal stents during thoracic endovascular aortic repair. Catheter Cardiovasc Interv. 2020;95(6):1163–1168.

Inoue

Hosokawa

Iwase

, et al. Aortic arch reconstruction by transluminally placed endovascular branched stent graft. Circulation. 1999;100(suppl 2):II316–II321.

van Bakel

de Beaufort

Trimarchi

, et al. Status of branched endovascular aortic arch repair. Ann Cardiothorac Surg. 2018;7(3):406–413.

Feng

Zhou

, et al. Endovascular repair by customized branched stent-graft: a promising treatment for chronic aortic dissection involving the arch branches. J Thorac Cardiovasc Surg. 2015;150(6):1631–1638. e5.

Lombardi

Hughes

Appoo

, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg. 2020;71(3):723–747.

Ramdon

Patel

Hnath

Yeh

Darling

RC III

. Chimney stent graft for left subclavian artery preservation during thoracic endograft placement. J Vasc Surg. 2020;71(3):758–766.

Fukushima

Ohki

Toya

, et al. Initial results of thoracic endovascular repair for uncomplicated type B aortic dissection involving the arch vessels using a semicustom-made thoracic fenestrated stent graft. J Vasc Surg. 2019;69(6):1694–1703.

10.

Zhang

Zhu

Jing

. Branch stent-grafting for endovascular repair of chronic aortic arch dissection. J Thoracic Cardiovasc Surg. 2019;S0022-5223(19)33104-6.

11.

Zhao

Fang

Yan

, et al. Outcomes of the Chimney technique for endovascular repair of aortic dissection involving the arch branches. Ann Vasc Surg. 2019;58:238–247. e3.

12.

Kuo

Huang

Chen

. Handmade fenestrated stent grafts to preserve all supra-aortic branches in thoracic endovascular aortic repair. J Thorac Cardiovasc Surg. 2020;160(3):629–639. e1. S0022-5223(19)31650-2.

13.

Qiu

Chen

Liao

, et al. Efficiency of modified triple-branched stent graft in type I aortic dissection: two-year follow-up. Ann Thoracic Surg. 2020;110(3):925–932. S0003-4975(20)30079-5.

14.

Kuo

Veranyan

Johnson

, et al. Impact of proximal seal zone length and intramural hematoma on clinical outcomes and aortic remodeling after thoracic endovascular aortic repair for aortic dissections. J Vasc Surg. 2019;69(4):985–995.

15.

Menichini

Pirola

Guo

Dong

. High wall stress may predict the formation of stent-graft-induced new entries after thoracic endovascular aortic repair. J Endovasc Ther. 2018;25(5):571–577.

16.

Bokoch

Hiramoto

Lobo

, et al. Rapid ventricular pacing for landing zone precision during thoracic endovascular aortic arch repair: a case series. J Cardiothorac Vasc Anesth. 2017;31(6):2141–2146.

17.

Kuo

Huang

Chen

. Handmade stent graft fenestration to preserve left subclavian artery in thoracic endovascular aortic repair. Eur J Cardiothorac Surg. 2019;56(3):587–594.

18.

Ferrer

Cao

Coscarella

, et al. Italian registry of double inner branch stent graft for arch pathology (the Triumph Registry). J Vasc Surg. 2019;70(3):672–682. e1.

19.

Law

Kolbel

Detter

, et al. Emergency use of branched thoracic endovascular repair in the treatment of aortic arch pathologies. Ann Thorac Surg. 2019;107(6):1799–1806.