Debranching Solutions in Endografting for Complex Thoracic Aortic Dissections

Abstract

BackgroundConventional surgical repair of thoracic aortic dissections is a challenge due to mortality and morbidity risks.ObjectivesWe analyzed our experience in hybrid aortic arch repair for complex dissections of the aortic arch.MethodsBetween 2009 and 2013, 18 patients (the mean age of 67 ± 8 years-old) underwent hybrid aortic arch repair. The procedural strategy was determined on the individual patient.ResultsThirteen patients had type I repair using trifurcation and another patient with bifurcation graft. Two patients had type II repair with replacement of the ascending aorta. Two patients received extra-anatomic bypass grafting to left carotid artery allowing covering of zone 1. Stent graft deployment rate was 100%. No patients experienced stroke. One patient with total debranching of the aortic arch following an acute dissection of the proximal arch expired 3 months after TEVAR due to heart failure. There were no early to midterm endoleaks. The median follow-up was 20 ± 8 months with patency rate of 100%.ConclusionVarious debranching solutions for different complex scenarios of the aortic arch serve as less invasive procedures than conventional open surgery enabling safe and effective treatment of this highly selected subgroup of patients with complex aortic pathologies.

Hybrid Repair versus Conventional Open Repair Approaches for Aortic Arch Disease: a Comprehensive Review

“…More recently, hybrid repair (HR), a combination of the open technique in association with the endovascular approach, emerged as a modern treatment modality for properly selected patients [ 5 ] . The hybrid procedure its fundamentally based in the supra-aortic vessels debranching from the arch to the ascending aorta, creating proximal and distal landing zones suitable for the endovascular insertion of the prosthetic graft [ 6 ] .…”

Early Experience of Thoracic and Abdominal Endovascular Aortic Repair: a Tertiary Single Centre

“…Aort anevrizma tedavisinde 1986 yılında, diseksiyon tedavisinde ise 1999 yılında cerrahiye alternatif stent tedavisi ilk sonuç-ları yayınlanmış ve ilerleyen dönemki çalışmalarla yüksek riskli bu hastalarda endovasküler aortik onarımın açık cerrahiye iyi bir alternatif olduğu gösterilmiştir (3)(4)(5)(6)(7) . Ülkemizde de son yıllarda akut ve elektif aortik patolojilerin abdominal endovasküler onarımı (EVAR) ve torakal endovasküler onarımlarım (TEVAR) tekniği giderek artan oranda kullanılmaktadır (8)(9)(10) .…”