Branched and fenestrated endovascular aortic arch repair in patients with native proximal aortic landing zone

Petroula Nana; Konstantinos Spanos; Giuseppe Panuccio; Fiona Rohlffs; Christian Detter; Yskert von Kodolitsch; José I Torrealba; Tilo Kölbel

doi:10.1016/j.jvs.2024.03.444

Branched and fenestrated endovascular aortic arch repair in patients with native proximal aortic landing zone

J Vasc Surg. 2024 Apr 3:S0741-5214(24)00931-5. doi: 10.1016/j.jvs.2024.03.444. Online ahead of print.

Authors

Petroula Nana¹, Konstantinos Spanos², Giuseppe Panuccio², Fiona Rohlffs², Christian Detter², Yskert von Kodolitsch², José I Torrealba², Tilo Kölbel²

Affiliations

¹ German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center UKE, Hamburg, Germany. Electronic address: petr.nana7@hotmail.com.
² German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center UKE, Hamburg, Germany.

PMID: 38580160
DOI: 10.1016/j.jvs.2024.03.444

Abstract

Objective: Fenestrated and branched thoracic endovascular repair (f/bTEVAR) have been successfully applied in patients with diverse aortic arch pathologies. The aim of this study is to present the early and mid-term outcomes of patients with native proximal aortic landing (NPAL) managed with f/bTEVAR.

Methods: A single-center retrospective analysis of patients with NPAL, managed with f/bTEVAR, between September 1, 2011, and June 30, 2022, was conducted. All patients were treated with custom-made devices (Cook Medical) with landing within Ishimaru zones 0 to 2. Primary outcomes were technical success, mortality, stroke, and retrograde type A dissection at 30 days. Follow-up outcomes were considered secondary.

Results: A total of 126 patients were included (69.8% males; mean age, 70.8 ± 4.2 years; 18.3% urgent). The main indications (60.4%) for repair were aortic arch (29.4%) and thoracoabdominal aortic aneurysms (31.0%). Seventy-two patients (57.1%) were managed with fTEVAR. Proximal landing in zone 0 and 1 was chosen in 97.6%. Technical success was 94.4%, and 30-day mortality was 11.9%. Strokes were diagnosed in 13.5% of patients and major strokes were identified in 7.9% cases. Retrograde type A dissection rate was 3.9%. The multivariate analysis confirmed landing in Ishimaru zone 0 as an independently related factor for stroke (P = .005), whereas stroke (P < .001), pericardial effusion (P < .001), and acute kidney injury (P < .001) were independently related to 30-day mortality. Mean follow-up was 17.5 ± 9.3 months. The estimated survival rate and the freedom from reintervention rate were 72.6% (standard error, 4.4%) and 46.4% (standard error, 6.0%) at 24-month follow-up, respectively.

Conclusions: Stroke rate after endovascular arch repair was alarming among patients with NPAL. Proximal landing to zone 0 was related to higher risk of stroke. Reinterventions were common within the 24-month follow-up.

Keywords: Aortic arch; Branched; Endovascular repair; Fenestrated; Mortality; Native aorta; Stroke.