Hybrid Repair of the Aortic Arch in Patients with Extensive Aortic Disease

• Published in: European journal of vascular and endovascular surgery 2010-12, Vol.40 (6), p.715-721
• Main Authors: Antoniou, G.A, Mireskandari, M, Bicknell, C.D, Cheshire, N.J.W, Gibbs, R.G, Hamady, M, Wolfe, J.H.N, Jenkins, M.P
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aorta, Abdominal - diagnostic imaging; Aorta, Abdominal - surgery; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Aortic aneurysm; Aortic arch; Aortic Diseases - diagnostic imaging; Aortic Diseases - mortality; Aortic Diseases - surgery; Aortography - methods; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - mortality; Chi-Square Distribution; Debranching; Endoleak - etiology; Endovascular; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Endovascular Procedures - mortality; Female; Humans; Hybrid treatment; Logistic Models; London; Male; Middle Aged; Patient Selection; Prosthesis Design; Retrospective Studies; Risk Assessment; Risk Factors; Stents; Surgery; Time Factors; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2010.08.024

Abstract Objective To evaluate the outcome of hybrid treatment of the aortic arch with supra-aortic debranching and endovascular stent-graft repair in a selected group of patients with complex disease. Design Case series study with retrospective analysis of prospectively collected non-randomised data. Methods Patients with hybrid repair of complex arch disease at a single centre over a 6-year period were enrolled in the study. Only patients with extensive arch pathologies requiring debranching of at least the left carotid artery were considered. Patients were divided into those who underwent complete and partial supra-aortic revascularisation. The χ2 test was used to evaluate differences in outcomes. Logistic regression analyses were applied to identify predictors of poor outcome. Results A total of 33 patients were included in the study. Complete and partial arch repair was performed in nine and 24 patients, respectively. The aortic disease extended to the thoracic and abdominal aorta in 39% and 52% of the patients, respectively. One-third of the patients (30%) were treated on an urgent/emergency basis. Elective 30-day mortality and morbidity rates were 13% and 35%, respectively. Early mortality was significantly higher in the complete arch repair group ( p  = 0.046). Pre-existing renal impairment was identified as a poor prognostic factor. All extra-anatomic bypasses remained patent and no aortic disease-related deaths occurred during a mean follow-up period of 23 months (range, 1.5–58 months). Complete arch repair was associated with an increased incidence of late endoleak ( p  = 0.018). Conclusions Hybrid treatment of the aortic arch provides a feasible alternative treatment in patients who are high risk for conventional open surgical repair. Careful selection of patients is required to achieve satisfactory results.