A Retrospective Analysis of 10-year Experience in Branched and Fenestrated Endovascular Aortic Arch Repair

Abstract

OBJECTIVE: This study aimed to present the early and mid-term outcomes of fenestrated/branched thoracic endovascular aortic repair (f/bTEVAR) for aortic arch pathologies. BACKGROUND: f/bTEVAR represents a less invasive treatment option for aortic arch diseases. Previous published series showed decreased early mortality and morbidity compared with open repair. METHODS: A single-center retrospective analysis of consecutive patients managed with f/bTEVAR (Cook Medical, Bloomington, IN) between September 1, 2011, and June 30, 2022, was conducted. Primary outcomes were technical success, 30-day mortality, and stroke. Data during follow-up and factors affecting early mortality and stroke were analyzed. RESULTS: A total of 209 patients were included (38.3% females; mean age 69.8±3.4 years; mean aortic diameter 61±4.7 mm); 14.4% were managed urgently. Fenestrations/scallop configuration was used in 39.7%, branched devices in 55.5%, and branch/scallop combination in 4.8%. Landing to zone 0 was performed at 65.5% and in zone 1 at 32.1%. Non-native aortas were used for landing in 39.7%. Technical success was 97.1%, and 30-day mortality was 9.5%. Strokes were identified in 10%, and 5.7% major. Non-native proximal aortic landing zone was an independent protective factor for stroke ( P =0.002). Postoperative stroke ( P <0.001) and pericardial effusion ( P <0.001) were independently related to 30-day mortality. The mean follow-up was 21±8 months. The estimated survival and freedom from reintervention rates were 79.5% (SE: 3.1%) and 47.1% (SE: 4.3%) at 24 months, respectively. CONCLUSIONS: f/bTEVAR presented high technical success and acceptable 30-day mortality. Non-native proximal landing zone was related to lower stroke rate. Half of the patients needed a reintervention within the 24-month follow-up.

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