title: Endovascular debranching of the aortic arch during thoracic endograft repair.
abstract: BACKGROUND
  Treatment of complex thoracic aortic pathology increasingly requires coverage of one or more aortic arch vessels. Endovascular debranching with a chimney technique can reduce or eliminate the need for surgical bypass. In this study, we evaluate our initial experience with planned endovascular debranching of the aortic arch.
  
  
  METHODS
  During a 13-month period, nine patients were treated with endovascular debranching during thoracic endograft placement. Balloon expandable (n = 7) or self-expanding stents (n = 2) were deployed (innominate, n = 2; left common carotid, n = 2; left subclavian, n = 5) along with either TAG (W. L. Gore, Flagstaff, Ariz; n = 8) or Talent (Medtronic, Minneapolis, Minn; n = 1) endografts. Four patients required six surgical bypasses to additional arch vessels (right to left common carotid artery, n = 2; left common carotid to subclavian artery, n = 4).
  
  
  RESULTS
  Indications for thoracic endograft placement were aortic transection (n = 4), aortic aneurysm (n = 2), aortotracheal fistula (n = 1), contained aortic aneurysm rupture (n = 1), and acute aortic dissection (n = 1). Endografts were deployed into zones 0 (n = 2), 1 (n = 2), and 2 (n = 5). Technical success of endovascular debranching was attained in eight of nine patients, with maintenance of branch perfusion and absence of endoleak. Perioperative morbidity included one myocardial infarction and one stroke that resulted in the patient's death. During subsequent follow-up (range, 2-25 months), there were no instances of endoleak secondary to chimney stents. All debranched vessels maintained primary patency.
  
  
  CONCLUSIONS
  Endovascular debranching permits planned extension of the thoracic endograft over arch vessels while further minimizing the need for open reconstruction. Short-term results indicate technical feasibility of this approach. Long-term outcomes remain undefined.
authors.affiliation: Section of Vascular and Endovascular Surgery, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Cires
authors.forename: Robert E
authors.initials: RE
authors.lastname: Noll
authors.forename: Francisco C
authors.initials: FC
authors.lastname: Albuquerque
authors.forename: Britt H
authors.initials: BH
authors.lastname: Tonnessen
authors.forename: W Charles
authors.initials: WC
authors.lastname: Sternbergh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents