Paolo Spath, Stefania Caputo, Enrico Gallitto, Antonino DI Leo, Gemmi Sufali, Rodolfo Pini, Andrea Vacirca, Gianluca Faggioli, Mauro Gargiulo
{"title":"主动脉弓血管内修复手术去分支的中期结果。","authors":"Paolo Spath, Stefania Caputo, Enrico Gallitto, Antonino DI Leo, Gemmi Sufali, Rodolfo Pini, Andrea Vacirca, Gianluca Faggioli, Mauro Gargiulo","doi":"10.1016/j.avsg.2025.09.042","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the outcomes of surgical debranching of supra-aortic trunks(dSAT) for the endovascular treatment of aortic arch pathologies.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"MID-TERM RESULTS OF SURGICAL DEBRANCHING FOR AORTIC ARCH ENDOVASCULAR REPAIR.\",\"authors\":\"Paolo Spath, Stefania Caputo, Enrico Gallitto, Antonino DI Leo, Gemmi Sufali, Rodolfo Pini, Andrea Vacirca, Gianluca Faggioli, Mauro Gargiulo\",\"doi\":\"10.1016/j.avsg.2025.09.042\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>To evaluate the outcomes of surgical debranching of supra-aortic trunks(dSAT) for the endovascular treatment of aortic arch pathologies.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":8061,\"journal\":{\"name\":\"Annals of vascular surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of vascular surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.avsg.2025.09.042\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of vascular surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.avsg.2025.09.042","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
MID-TERM RESULTS OF SURGICAL DEBRANCHING FOR AORTIC ARCH ENDOVASCULAR REPAIR.
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
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
