Paolo Spath, Stefania Caputo, Enrico Gallitto, Antonino DI Leo, Gemmi Sufali, Rodolfo Pini, Andrea Vacirca, Gianluca Faggioli, Mauro Gargiulo
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引用次数: 0
Abstract
Introduction: To evaluate the outcomes of surgical debranching of supra-aortic trunks(dSAT) for the endovascular treatment of aortic arch pathologies.
Methods: Single-center retrospective analysis (2014-2024) of patients undergoing dSAT associated with endovascular treatment involving thoracic endovascular repair (TEVAR) in the aortic arch, was performed. Primary endpoints were defined on dSAT; secondary endpoints on patients. Subgroup analyses considered dSAT combined vs deferred to endovascular procedure. Cross-table analysis was performed for categorial variables and Kaplan-Meier for follow-up analysis.
Results: Eighty-two patients (mean age:71, 78% male), were included. Pathologies included aortic arch(24%) and thoracic/thoracoabdominal(76%) diseases. A total of 87 dSAT were performed: a left common carotid artery(LCCA)-left subclavian artery(LSA) bypass in 57(70%) cases, a right-common carotid artery to LSA with reimplant of LCCA in 18(22%), bilateral carotid-subclavian bypasses in 5(6%), two(2%) direct reimplants(LCCA; vertebral artery). Seventy patients(85%) had a single and 12(15%) had a deferred endovascular repair. Technical success was 100%. 30-days dSAT related reinterventions were 7(8%)(one arterial dissection and 6 bleedings). Non-surgical dSAT complications were 4(5%)(3 left vocal cord paralysis; 1 chylothorax). Thirty-day mortality was 8%(7 patients), unrelated to dSAT. No cases of stroke were reported. Subgroup analysis showed absence of debranching related complications/reinterventions in deferred group. Median follow-up 20 months(IQR10-37). Follow-up debranching primary patency was 100% without reinterventions.
Conclusions: The dSAT is a safe and effective procedure for endovascular treatment of aortic pathologies involving the aortic arch. Patency is high and reinterventions/complications are mainly linked to bleedings and seem to have a positive trend when endovascular procedure is performed in deferred stage.
期刊介绍：
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence
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