The use of a custom-made branched endograft to treat chronic aortic arch dissections was associated with low mortality and low stroke rates in a new study. Despite the mortality and stroke benefit associated with this approach, the branched endograft was associated with high rates of reintervention. Findings from the study were published in the Annals of Surgery.

Consecutive patients with Stanford type A acute aortic dissection who were scheduled to undergo an arch branched endograft repair following an ascending aorta or hemiarch replacement were included in the retrospective analysis (N=70). Patient data were pooled from a total of 14 high-volume aortic centers. The A-Branch endograft, which includes either 3 branches or 2 distinct branches for the innominate artery and 1 left common carotid artery, was used. Researchers evaluated the rates of in-hospital mortality and stroke, technical success, early and late complications, reinterventions, and mortality during a median follow-up of 301 (interquartile range, 138-642) days.

The combined in-hospital mortality and stroke rate was 4% (n=3) and included minor stroke (n=1), major stroke resulting in death (n=1), and death following multiorgan failure (n=1). Technical success was reported in 94.3% of patients. Although the rate of mortality and stroke was low, early reinterventions occurred in 17.1% of patients, whereas 29% of patients underwent a second intervention during follow-up.

Early interventions were caused by vascular access complications (n=8), endoleak correction (n=2), and pericardial effusion drainage (n=2). Conversely, secondary interventions were caused by endoleak corrections (n=9), open repair for prosthetic kink (n=1), and distal extensions of the graft to the thoracic or thoracoabdominal aorta (n=10). Death occurred in 11% (n=8) of patients, with 7 cases of death from nonaortic-related causes.

Limitations of the study include its retrospective design, the use of only 1 device, and the lack of a control group.

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“Endovascular arch repair offers the possibility to extend the distal treatment level further toward the celiac artery including false lumen occlusion obviating the need for another [thoracic endovascular aortic repair] procedure,” the researchers wrote. “Further follow-up is required before wider application of this novel approach can be recommended.”

Disclosure: Multiple authors disclosed affiliations with Cook Medical.

Reference

Verscheure D, Haulon S, Tsilimparis N, et al. Endovascular treatment of post type A chronic aortic arch dissection with a branched endograft: early results from a retrospective international multicenter study [published online April 8, 2019]. Ann Surg. doi:10.1097/SLA.0000000000003310