Endovascular repair for thoracic aortic arch aneurysms.
OBJECTIVE
The aim of this study was to report our experience with total and subtotal endovascular stent-grafting combined with aortic arch branch surgical revascularization for thoracic aortic arch aneurysms in high-risk patients.


METHODS
From December 2000 to June 2005, among 38 patients treated with thoracic stent-grafts in our department, 10 patients (9 men; mean age 71+/-6 years) at high risk for open repair were candidates for endovascular repair and/or aortic arch branch extra-anatomical reconstruction due to inadequate proximal landing zones. The left subclavian artery was over-stented 6 cases for zone 2 aneurysms, and partial or total arch stent-grafting with simultaneous revascularization of the arch branches was performed in 4 cases for zones 0-1 aneurysms.


RESULTS
Primary technical success rate was 100%. In-hospital mortality rate was 10%. Neither paraplegia, nor acute renal failure were recorded. Immediate or late surgical conversion was never required. One type 1b was successfully treated with additional stent-graft and 2 type-2 endoleaks were sealed by coil embolization. Mean follow-up was 21-months (range 3-48 months); overall, survival rate at 12, 26, and 36 months was 90%, 60%, and 30%, respectively.


CONCLUSIONS
Endovascular repair for thoracic aortic arch aneurysms is feasible. However, our experience suggests stent-grafting is not free of risk, and long-term and larger follow-up is required.
Caronno
R
R
Division of Vascular Surgery, Department of Surgery, University of Insubria, Varese, Italy.
Piffaretti
G
G
Tozzi
M
M
Lomazzi
C
C
Cuffari
S
S
Sala
A
A
Castelli
P
P
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000784:Aortic Dissection / Q000473:pathology / Q000601:surgery; D017130:Angioplasty / Q000379:methods*; D017545:Aortic Aneurysm, Thoracic / Q000473:pathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D017536:Carotid Artery, Common / Q000601:surgery; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013348:Subclavian Artery / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency