title: Is total debranching a safe procedure for extensive aortic-arch disease? A single experience of 27 cases.
abstract: OBJECTIVE
  Thoracic, arch, and proximal descending thoracic aorta diseases are still considered an enormous challenge. The hybrid approach developed in recent years (supra-aortic trunks debranching and thoracic endovascular repair aortic repair; TEVAR) may improve the morbidity and mortality of the population at risk. The aim of this study was to analyze retrospectively our experience in the hybrid treatment of aortic-arch aneurysms and dissections.
  
  
  METHODS
  We carried out a retrospective review of 27 patients who required a surgical debranching of the supra-aortic trunks and a TEVAR in the management of the aortic arch and proximal descending thoracic aortic disease. The aortic lesions included 18 degenerative arch-aortic aneurysms, four complicated aortic dissections, two subclavian artery aneurysms, and three penetrating atherosclerotic ulcers. Technical success was achieved in all patients.
  
  
  RESULTS
  The 30-day mortality rate was 11.1% (3/27). Mean follow-up was 16.7 months (range, 1-56), and the survival rate was 77.8%. The endoleaks' rate was 3.7% (1/27), due to a stent-graft migration.
  
  
  CONCLUSIONS
  Hybrid approaches may represent an alternative option in the treatment of complex aortic lesions involving the arch and the proximal descending thoracic aorta in high-risk patients and emergency cases. However, the promising early results need to be confirmed by longer follow-up and larger comparative series.
authors.affiliation: Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Largo Turati 62, 10128 Turin, Italy. emaferrero@libero.it
authors.forename: Emanuele
authors.initials: E
authors.lastname: Ferrero
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Ferri
authors.forename: Andrea
authors.initials: A
authors.lastname: Viazzo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Robaldo
authors.forename: Edoardo
authors.initials: E
authors.lastname: Zingarelli
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sansone
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casabona
authors.forename: Franco
authors.initials: F
authors.lastname: Nessi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000473:pathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000473:pathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome