Andrea Vacirca, Gianluca Faggioli, Stefania Caputo, Antonino Di Leo, Enrico Gallitto, Mauro Gargiulo
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引用次数: 0
Abstract
Objective: Type B acute aortic syndrome (AAS) and thoracic or thoraco-abdominal aortic aneurysm (TAA/TAAA) requiring proximal sealing in Ishimaru zone 2 have traditionally been managed with thoracic endovascular aortic repair (T-EVAR), often combined with carotid-subclavian bypass. The new Gore Thoracic Branch Endograft (TBE) facilitates the treatment of distal aortic arch lesions by including the left subclavian artery yet maintaining its patency. This study aimed to assess the anatomical feasibility of TBE in patients treated or awaiting treatment for AAS or TAA/TAAA requiring proximal seal in zone 2.
Methods: This was a retrospective cohort analysis of all patients with AAS or TAA/TAAA referred to a single centre (January 2018 to March 2025) requiring proximal seal in zone 2 and with an indication for endovascular repair. Pre-operative computed tomography scans were reviewed. Anatomical feasibility (AF) was defined according to the TBE instructions for use. Iliac feasibility (IF) was determined based on iliofemoral diameters and calcification. True feasibility (TF) was the combination of AF and IF.
Results: During the study period, 93 patients (78% male; median age at presentation 72 years [interquartile range 16]) were enrolled, of whom 65 (70%) had AAS and 28 (30%) had TAA/TAAA. T-EVAR with CSB was performed in 53% (49/93), T-EVAR with LSA coverage in 26% (24/93), and TBE in 5% (5/93); 16% (15/93) were awaiting endovascular repair. The overall AF for TBE was 92%, while TF was 85%, with seven patients showing hostile iliofemoral axes. There were no statistically significant differences in TBE AF (AAS 91% vs. TAA/TAAA 96%; p = .67) and TF (AAS 85% vs. TAA/TAAA 86%; p = 1.0) among patients with AAS and TAA/TAAA.
Conclusion: TBE showed high AF in both AAS and TAA/TAAAs requiring proximal sealing in zone 2. However, the elevated profile of the endograft may be considered a concern in patients with hostile iliofemoral axes.
期刊介绍：
The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles.
Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.
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