OBJECTIVES: Hybrid aortic arch repair procedure was introduced to reduce invasiveness in high-risk patients with aortic arch pathology. The good results are expanding its application, but endoleak, particularly type I, remains its Achilles' heel. DESIGN: We describe our experience with hybrid treatment of aortic arch diseases focussing on techniques and results to avoid type I endoleak. MATERIALS AND METHODS: A total of 15 high-risk patients with zone 0-2 aortic arch pathology underwent supra-aortic debranching on ascending aorta and proximal aortic arch reinforcement with a Dacron prosthesis. Metachronously, the procedure was completed with endovascular stent grafting (ESG). RESULTS: Median age was 70 years with a mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 12.7±6.8. One patient died between aortic debranching and ESG. Mean time between surgical debranching and ESG was 32±27.7 days. No major neurological events occurred. Mean length of the landing zone for ESG was 3.8±0.8 cm. Computed tomography (CT) angiography scan performed soon after operation, and at 3, 6, and 12 months did not show any type I endoleak. CONCLUSIONS: Supra-aortic debranching on ascending aorta with proximal aortic arch reinforcement is a useful step to ensure a safe landing zone for ESG, reducing risk early to midterm of endoleak. Longer term follow-up is required to confirm the viability of this technique.
Hybrid aortic arch repair procedure : reinforcement of the aorta for a safe and durable landing zone / G. Gelpi, P. Vanelli, A. Mangini, P. Danna, M. Contino, C. Antona. - In: EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY. - ISSN 1078-5884. - 40:6(2010 Dec), pp. 709-714. [10.1016/j.ejvs.2010.08.017]
Hybrid aortic arch repair procedure : reinforcement of the aorta for a safe and durable landing zone
M. ContinoPenultimo
;C. AntonaUltimo
2010
Abstract
OBJECTIVES: Hybrid aortic arch repair procedure was introduced to reduce invasiveness in high-risk patients with aortic arch pathology. The good results are expanding its application, but endoleak, particularly type I, remains its Achilles' heel. DESIGN: We describe our experience with hybrid treatment of aortic arch diseases focussing on techniques and results to avoid type I endoleak. MATERIALS AND METHODS: A total of 15 high-risk patients with zone 0-2 aortic arch pathology underwent supra-aortic debranching on ascending aorta and proximal aortic arch reinforcement with a Dacron prosthesis. Metachronously, the procedure was completed with endovascular stent grafting (ESG). RESULTS: Median age was 70 years with a mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) of 12.7±6.8. One patient died between aortic debranching and ESG. Mean time between surgical debranching and ESG was 32±27.7 days. No major neurological events occurred. Mean length of the landing zone for ESG was 3.8±0.8 cm. Computed tomography (CT) angiography scan performed soon after operation, and at 3, 6, and 12 months did not show any type I endoleak. CONCLUSIONS: Supra-aortic debranching on ascending aorta with proximal aortic arch reinforcement is a useful step to ensure a safe landing zone for ESG, reducing risk early to midterm of endoleak. Longer term follow-up is required to confirm the viability of this technique.File | Dimensione | Formato | |
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