title: Editor's Choice - Subsequent Results for Arch Aneurysm Repair with Inner Branched Endografts.
abstract: OBJECTIVE
  The aim was to evaluate the current results of aortic arch aneurysm repair using inner branched endografts performed in three high volume aortic endovascular centers and to compare them to the pioneering global experience with this technology.
  
  
  METHODS
  Included patients underwent repair of aortic arch aneurysms >55 mm in diameter using inner branched endograft technology between April 2013 and November 2014. All patients were deemed unfit for open surgery. Inner branches were designed to perfuse the brachiocephalic trunk and the left common carotid artery in all cases. A left subclavian artery (LSA) revascularization was performed prior to the arch endovascular repair. Data were collected retrospectively in an electronic database. Parameters included length of procedure, fluoroscopy time, contrast volume, technical success, presence of endoleaks, early and late complications, and mortality.
  
  
  RESULTS
  Twenty-seven patients were included in the study. Technical success was achieved in all cases. No patients died during the 30 day post-operative period. Early neurologic events included two major strokes (7.4%) and one minor stroke (3.7%). Transient spinal cord ischemia with full recovery was observed in two patients (7.4%). Four patients (14.8%) underwent early (<30 day) re-interventions; these were for an access complication, an ischemic limb and exploration of the left ventricle through a sternotomy in two patients. During follow up (median 12 months), one patient (3.7%) died from a remote thoraco-abdominal aneurysm rupture. There were three Type 2 endoleaks (11.1%). Two re-interventions (7.4%) were performed, one to treat a Type 2 endoleak and one to treat a septic false aneurysm. A significant decrease in overall mortality was observed when comparing patients from the early experience with patients from the current report.
  
  
  CONCLUSIONS
  The early outcomes associated with this technology are favorable. Branched endografting of aortic arch aneurysms should be considered in patients unfit for open surgery.
authors.affiliation: Aortic Centre, CHRU Lille, France.
authors.forename: R
authors.initials: R
authors.lastname: Spear
authors.affiliation: Aortic Centre, CHRU Lille, France. Electronic address: stephan.haulon@chru-lille.fr.
authors.forename: S
authors.initials: S
authors.lastname: Haulon
authors.affiliation: Vascular Surgery, Jikei University, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ohki
authors.affiliation: German Aortic Center, University Heart Center Hamburg, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Tsilimparis
authors.affiliation: Vascular Surgery, Jikei University, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kanaoka
authors.affiliation: Aortic Centre, CHRU Lille, France.
authors.forename: C P E
authors.initials: CP
authors.lastname: Milne
authors.affiliation: German Aortic Center, University Heart Center Hamburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Debus
authors.affiliation: Vascular Surgery, Jikei University, Tokyo, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Takizawa
authors.affiliation: German Aortic Center, University Heart Center Hamburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Kölbel
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000379:methods*
keywords: Aortic arch aneurysm; Endovascular repair; Inner branched endograft