title: Global experience with an inner branched arch endograft.
abstract: BACKGROUND
  Branched endografts are a new option to treat arch aneurysm in high-risk patients.
  
  
  RESULTS
  We performed a retrospective multicenter analysis of all patients with arch aneurysms treated with a new branched endograft designed with 2 inner branches to perfuse the supra aortic trunks. Thirty-eight patients were included. The median age was 71 years (range, 64-74 years). An American Society of Anesthesiologists score of 3 or 4 was reported in 89.5% (95% confidence interval [CI], 79.7-99.3) of patients. The 30-day mortality rate was 13.2% (95% CI, 2.2-24.2). Technical success was obtained in 32 patients (84.2% [95% CI, 72.4-95.9]). Early secondary procedures were performed in 4 patients (10.5% [95% CI, 0.7-20.3]). Early cerebrovascular complications were diagnosed in 6 patients (15.8% [95% CI, 4.0-27.6]), including 4 transient ischemic attacks, 1 stroke, and 1 subarachnoid hemorrhage. The median follow-up was 12 months (range, 6-12 months). During follow-up, no aneurysm-related death was detected. Secondary procedures during follow-up were performed in 3 patients (9.1% [95% CI, 0.0-19.1]), including 1 conversion to open surgery. We compared the first 10 patients (early experience group) with the subsequent 28 patients. Intraoperative complications and secondary procedures were significantly higher in the early experience group. Although not statistically significant, the early mortality was higher in the early experience group (30% [95% CI, 0.0-60.0]) versus the remainder (7.1% [95% CI, 0.0-16.9]; P=.066). Being part of the early experience group and ascending aortic diameter≥38 mm were found to be associated to higher rates of combined early mortality and neurologic complications.
  
  
  CONCLUSIONS
  Our preliminary study confirms the feasibility and safety of the endovascular repair of arch aneurysms in selected patients who may not have other conventional options.
  
  
  BACKGROUND
  Thoracic IDE NCT00583817, FDA IDE# 000101.
authors.affiliation: Aortic Centre, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France. Electronic address: stephan.haulon@chru-lille.fr.
authors.forename: Stéphan
authors.initials: S
authors.lastname: Haulon
authors.affiliation: Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Roy K
authors.initials: RK
authors.lastname: Greenberg
authors.affiliation: Aortic Centre, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France.
authors.forename: Rafaëlle
authors.initials: R
authors.lastname: Spear
authors.affiliation: Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Matt
authors.initials: M
authors.lastname: Eagleton
authors.affiliation: Vascular Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Cherrie
authors.initials: C
authors.lastname: Abraham
authors.affiliation: Vascular Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Christos
authors.initials: C
authors.lastname: Lioupis
authors.affiliation: Vascular and Endovascular Surgery, Klinikum Nürnberg Süd, Nürnberg, Germany.
authors.forename: Eric
authors.initials: E
authors.lastname: Verhoeven
authors.affiliation: Vascular Surgery, Royal Free Hospital, London, England.
authors.forename: Krassi
authors.initials: K
authors.lastname: Ivancev
authors.affiliation: Vascular Medecine, University Hospital Eppendorf, Hamburg, Germany.
authors.forename: Tilo
authors.initials: T
authors.lastname: Kölbel
authors.affiliation: Vascular Surgery, Fremantle Hospital, Perth, Australia.
authors.forename: Brendan
authors.initials: B
authors.lastname: Stanley
authors.affiliation: Vascular Center, Skane University Hospital, Malmö, Sweden.
authors.forename: Timothy
authors.initials: T
authors.lastname: Resch
authors.affiliation: Vascular Center, Centre Hospitalier Universitaire Mondor, Créteil, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Desgranges
authors.affiliation: Aortic Centre, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France.
authors.forename: Blandine
authors.initials: B
authors.lastname: Maurel
authors.affiliation: Cook Medical, Bloomington, Ind.
authors.forename: Blayne
authors.initials: B
authors.lastname: Roeder
authors.affiliation: Vascular Surgery, Univeristy of California, San Francisco, San Francisco, Calif.
authors.forename: Timothy
authors.initials: T
authors.lastname: Chuter
authors.affiliation: Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Tara
authors.initials: T
authors.lastname: Mastracci
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome