Results of endovascular aortic arch repair using the Relay Branch system

Abstract

OBJECTIVES Our goal was to evaluate results of endovascular aortic arch repair using the Relay Branch system. METHODS Forty-three patients with thoracic aortic pathology involving the aortic arch have been treated with the Relay Branch system (Terumo Aortic, Sunrise, FL, USA) in 10 centres. We assessed in-hospital mortality, neurological injury, treatment success according to current reporting standards and the need for secondary interventions. In addition, outcome was analysed according to the underlying pathology: non-dissective disease versus residual aortic dissection (RAD) (defined as remaining dissection after previous type A repair, chronic type B aortic dissections). RESULTS In-hospital mortality was 9% (0% in patients with RAD). Disabling stroke occurred in 7% (0% in patients with RAD); non-disabling stroke occurred in 19% (7% in patients with RAD). Early type IA and B endoleak formation occurred in 4%. Median follow-up was 16 ± 18 months. During the follow-up period, 23% of the patients died. Aortic-related deaths were low (3% in patients with RAD). CONCLUSIONS The results of endovascular aortic arch repair using the Relay Branch system in a selected patient population with regard to technical success are good. In-hospital mortality is acceptable, the number of disabling strokes is low and technical success is high. Non-disabling stroke is a major concern, and every effort has to be taken to reduce this to a minimum. The best outcome is seen in patients with underlying RAD. Finally, more data are needed.

Does endovascular duration impact clinical outcomes in aortic arch repair? The RELAY™ branched international stance

“…These are complications that adversely impact a patient's quality of life, albeit at a lower rate than that of open surgical repair ( 17 ). Indeed, our data suggest that RELAY™ Branched is associated with a more favorable neurological risk profile than that reported by colleagues, whilst also ensuring that clinicians treat these complexities with on-label device use at all times ( 8 , 15 , 18 ).…”

“…Tazaki et al, in their analysis of outcomes associated with the Inoue TM triple-branched endoprosthesis, report a combined stroke rate of 40%, while Sato et al reported a 16.7% (n = 6) stroke rate with the Najuta TM fenestrated endograft (16, 18). Czerny et al observed a combined stroke rate of 20% in their series (8). Additionally, Sato et al reported that aneurysmal shrinkage post-intervention was observed in only 11 (30.6%) patients, while no change in aneurysmal size was observed in 15 (41.7%) (16).…”

“…It should be also highlighted that planting the endoprosthesis deep within zone 0 exposes it to maximal hemodynamic pressure, increasing the risk of malorientation as a result of the windsock effect ( 7 ). In view of these spatial constraints, shorter and wider endoprosthetic dimensions are favored, and 15% oversizing of the endoprosthesis relative to the native aortic diameter is considered to improve sealing ( 8 ). This clearly justifies the need for custom-made aortic arch endoprostheses licensed for on-label use throughout zones 0–4, to which RELAY™ Branched is eminently suited.…”

Type 1A Endoleak after TEVAR in the Aortic Arch: A Review of the Literature

“…Out of the 48 studies selected: 10 [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ] described outcomes in chimney procedures, 13 [ 1 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ] with the use of fenestrated devices, 9 [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] focused on in situ fenestration outcomes, 14 [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ] on branched devices, one study compared fenestrated and branched devices [ 48 ], and one compared in situ fenestration and the chimney technique [ 49 ].…”

“…Clough et al [ 35 ], Ferrer et al [ 38 , 39 ], and Dai et al [ 37 ] did not report any type I endoleaks. Type IA endoleaks were described by Chen et al [ 34 ] (1 in 122 patients), Czerny et al [ 36 ] (1 in 43 patients), Kawajiri et al [ 40 ] (2 in 11), Patel et al [ 42 ] (4 in 22 patients), Tazaki et al [ 43 ] (8 in 217 patients), Verscheure et al [ 46 ] (2 in 70 patients), and Tsilimparis et al [ 44 , 45 ] (with two experiences in which 2 out of 54 patients and 1 out of 20 patients), with an incidence ranging from 0.7 to 20%. A type 1B endoleak was described by Czerny et al [ 47 ] (1 in 43 patients), Li et al [ 41 ] (1 in 16), and Tazaky et al [ 43 ] (1 in 217).…”