All consecutive AARSA repairs from 2006 to 2013 in seven centers were reviewed. End points were 30-day and late mortality, reintervention rate, and AARSA-related death.
RESULTS: Twenty-one AARSA repairs were included (57% men; mean age, 67 years); 3
ruptures (14%) required emergent treatment; 12 (57%) were symptomatic for
dysphagia (33%),
dysphonia (24%), or
pain (19%). Eight cases (38%) presented with
thoracic aortic aneurysm, two with intramural
hematoma, and one with acute type B
aortic dissection. Mean AARSA diameter was 4.2 cm; a single bicarotid common trunk was present in 38% of cases. The majority of patients underwent hybrid intervention (n = 15; 71%) consisting of single (n = 2) or bilateral (n = 12) subclavian to carotid transposition or bypass or ascending aorta to subclavian bypass (n = 1) plus
thoracic endovascular aortic repair (
TEVAR); 19% of cases underwent open repair and 9% simple
TEVAR with AARSA overstenting. Perioperative death occurred in two patients (9%): in one case after
TEVAR in ruptured AARSA, requiring secondary
sternotomy and aortic banding; and in an elective case due to multiorgan failure after a hybrid procedure. Median follow-up was 30 (interquartile range, 15-46) months. The Kaplan-Meier estimate of survival at 36 months was 90% (standard error, 0.64). Late AARSA-related death in one case was due to AARSA-
esophageal fistula presenting with continuing backflow from distal AARSA and previous
TEVAR. At computed tomography controls, one type I
endoleak and one type II
endoleak were detected; the latter required reintervention by
aneurysm wrapping and
ligature of collaterals. AARSA-related death was more frequent after
TEVAR, a procedure reserved for
ruptures, compared with elective open or hybrid repair.
CONCLUSIONS: Hybrid repair is the preferred therapeutic option for patients presenting with AARSA. Midterm results show high rates of clinical success with low risk of reintervention. Simple endografting presents high risk of related death; these findings underline the importance of achieving complete sealing to avoid treatment failures.