Endovascular Outcomes in Aortic Arch Repair with Double and Triple Parallel Stent Grafts.

Abstract

PURPOSE:

To report early and midterm outcomes of treating thoracic aortic aneurysm (TAA) and aortic dissection (AD) involving zone 1 and zone 0 with multiple parallel stent grafts (PSGs).

MATERIALS AND METHODS:

From February 2011 to August 2018, 31 of 1,806 patients (1.7%) who underwent thoracic endovascular aortic repair (TEVAR) with double PSGs (DPSGs) (n = 20) or triple PSGs (TPSGs) (n = 11) were retrospectively reviewed. Procedures were performed in high-risk patients who had TAA or AD involving zone 1 or zone 0.

RESULTS:

Fifteen patients (48.4%) who presented with symptomatic or impending rupture underwent urgent or emergent TEVAR with DPSGs or TPSGs. Nineteen patients (61.3%) were treated for zone 0 disease. Technical and clinical success rates were 70.0% for DPSG cohort and 45.5% for TPSG cohort. Intraoperative type Ia endoleak was observed in 30% of DPSG cohort and 45.5% of TPSG cohort. One patient in the DPSG cohort died of aortic sinus rupture intraoperatively. Minor stroke during the 30-day postoperative period was more frequent in the TPSG cohort (P = .042). Mean duration of follow-up was 28.9 months ± 17.7. The TPSG cohort had a higher incidence of major adverse events (72.7% vs 25.0%, P = .021). The most common adverse events were endoleaks (12.9%), endograft migration (9.7%), PSG stenosis or occlusion (6.5%), retrograde dissection (6.5%), and stroke (3.2%). Endograft migrations were more common in TPSG cohort (27.3%, P = .037). Overall mortality rate was 16.1% (5/31) perioperatively and during follow-up. There were no statistical differences in overall survival and reintervention-free survival.

CONCLUSIONS:

In the context of TEVAR with multiple PSGs for aortic arch repair, TPSGs may have a high risk of major complications.

• Authors: Baolei Guo, Daqiao Guo, Bin Chen, Zhenyu Shi, Zhihui Dong, Cheng Yan, Weiguo Fu
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 31 Issue 12 Pg. 1984-1992.e1 (12 2020) ISSN: 1535-7732 [Electronic] United States
• PMID: 33153865 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2020 SIR. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Aortic Dissection (diagnostic imaging, mortality, surgery)
• Aorta, Thoracic (diagnostic imaging, surgery)
• Aortic Aneurysm, Thoracic (diagnostic imaging, mortality, surgery)
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation (adverse effects, instrumentation, mortality)
• Endovascular Procedures (adverse effects, instrumentation, mortality)
• Female
• Humans
• Male
• Middle Aged
• Postoperative Complications (mortality, therapy)
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Stents
• Time Factors
• Treatment Outcome