title: Long term outcome for extra-anatomic arch reconstruction. An analysis of 143 procedures.
abstract: OBJECTIVE
  With the FDA approval of thoracic endografts, extra-anatomic reconstruction of the aortic arch has allowed for more suitable proximal landing zones and increased applicability of thoracic endovascular procedures. We evaluated our short term and long term results of extra-anatomic reconstruction of the carotid and subclavian vessels.
  
  
  METHODS
  One hundred and forty three (143) procedures were performed for extra-anatomic carotid and subclavian reconstruction. Of these 143 operations: 85 were carotid subclavian reconstructions, 22 were carotid crossover bypasses, 30 were subclavian carotid reconstructions and 6 were carotid subclavian transpositions. Sixty (42%) were male, 20 (14%) were diabetic, and 63 (44%) were current smokers. Mean age was 63 (SD +/- 12.3). Indication for surgery was primarily for occlusive or embolic disease (97%). In those patients undergoing bypass graft, prosthetic (ePTFE) was used in 93%. Follow-up was performed at 3 and 6 month intervals by ultrasound and pulse volume recordings where indicated. Life table analyses were used to analyze patency.
  
  
  RESULTS
  Of the 143 reconstructions operative mortality was 1 (0.7%). Non-fatal complications included 3 (2.1%) for bleeding, 1 (0.7%) wound infection, 2 (1.4%) TIA, 1 (0.7%) suffered a non-fatal stroke, 2 (1.4%) had postoperative myocardial infarctions, and 6 (4.3%) late (>30-day) occlusions. Follow-up was 1 to 124 months (mean: 39 months). Primary patency at 1 year was 98%, 3 years 96%, and 5 years was 92%.
  
  
  CONCLUSIONS
  Extra-anatomic arch reconstruction can be performed safely and appears to be durable over long term follow-up. Its use with endovascular grafting should provide a durable reconstruction for patients who require aortic "debranching" prior endovascular thoracic aortic aneurysm repair.
authors: The Institute for Vascular Health and Disease, Albany Medical College/Albany Medical Center Hospital, Albany, NY, USA.
authors: J
authors: J
authors: Byrne
authors: R C
authors: RC
authors: Darling
authors: S P
authors: SP
authors: Roddy
authors: M
authors: M
authors: Mehta
authors: P S K
authors: PS
authors: Paty
authors: P B
authors: PB
authors: Kreienberg
authors: B B
authors: BB
authors: Chang
authors: K J
authors: KJ
authors: Ozsvath
authors: Y
authors: Y
authors: Sternbach
authors: D M
authors: DM
authors: Shah
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000601:surgery; D001807:Blood Vessel Prosthesis; D002339:Carotid Arteries / Q000601:surgery*; D004617:Embolism / Q000601:surgery; D005260:Female; D006083:Graft Occlusion, Vascular / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011138:Polytetrafluoroethylene; D012042:Registries; D019233:Retreatment; D013348:Subclavian Artery / Q000601:surgery*; D014654:Vascular Patency; D014656:Vascular Surgical Procedures
chemical_list: D011138:Polytetrafluoroethylene