title: [Outcomes of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures].
abstract: OBJECTIVE
  To summarize the experience of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures.
  
  
  METHODS
  It was a retrospective study. From January 2002 to December 2014, 42 high risk patients with aortic arch disease were treated by supra-arch debranching hybrid with subsequent endovascular repair in the First Affiliated Hospital of Sun Yat-sen University. There were 39 male and 3 female patients with a mean age of (53±13) years (ranging from 34 to 80 years). Of the 42 patients, 7 were thoracic aortic aneurysm, 20 were Stanford type B aortic dissection and 15 were Stanford type A aortic dissection. After the supra-aortic debranching technique, simultaneous (n=16) or staged (n=26, mean interval (7±3) days) endovascular repair were performed. Fisher exact test was used to compare the in-hospital mortality of ascending aorta based debranching and non-ascending aorta based debranching.
  
  
  RESULTS
  Technical success rate was 81.0% (34/42). The overall 30-day complication rate was 31.0% (13/42), including 3 cerebral stroke (7.1%), 8 endoleak (19.0%, including 6 type I endoleak and 2 type II endoleak), 1 circulatory failure, 1 aorto-tracheal fistula. The 30-day mortality was 9.5% (4/42), 2 died of cerebral stroke, 1 died of circulatory failure, 1 died of aorto-tracheal fistula. The in-hospital mortality of ascending aorta based debranching group was obviously higher than that of the non-ascending aorta based debranching group (4/16 vs. 0, P=0.02). The median time of follow-up was 64.8 (2 to 156.9) months. CT scanning was performed at 1, 3 months after surgery and annually thereafter. The overall survival rate was 76.6%. During the follow-up period, there was 4 deaths, and 2 of them were aortic artery related (5.3%). There were 4 de novo complications during the follow-up period, 1 stroke attributed to bypass occlusion was cured by medical treatment, 2 pseudoaneurysm was successfully treated with open surgery, 1 stent-graft induced new distal entry tear was successfully treated with a tapered stent-graft, there was no new endoleak during follow up period, 3 type I endoleak disappeared spontaneously, and 1 type II endoleak disappeared after secondary intervention.
  
  
  CONCLUSIONS
  Endovascular repair of aortic arch disease hybrid with supra-arch debranching procedure is low invasive with favorable long-term outcomes. It is suitable for high risk patients of poor general condition with little tolerance to aortic arch replacement. The in-hospital mortality is higher in the ascending aorta based debranching group than in the non-ascending aorta based debranching group. Stroke is a critical fatal complication and should be attached attention.
authors.affiliation: Department of Vascular Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
authors.forename: Mian
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Vascular Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Email: 13922231628@163.com.
authors.forename: Guangqi
authors.initials: G
authors.lastname: Chang
authors.affiliation: Department of Vascular Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
authors.forename: Henghui
authors.initials: H
authors.lastname: Yin
authors.affiliation: Department of Vascular Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Yao
authors.affiliation: Department of Vascular Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
authors.forename: Jinsong
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Vascular Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
authors.forename: Shenming
authors.initials: S
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery; D001011:Aorta / Q000473:pathology / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D057867:Endoleak / Q000150:complications; D057510:Endovascular Procedures; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000150:complications; D015996:Survival Rate; D014057:Tomography, X-Ray Computed