Great vessels transposition and aortic arch exclusion.

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Thoracic Surgery

Background:

• Thoracic aortic aneurysms and dissections (TAAD) involving the aortic arch pose significant challenges, especially in high-risk patients (HRP).
• Endovascular repair offers a less invasive alternative, but arch involvement requires complex strategies.

Purpose of the Study:

• To describe the experience with endovascular repair of TAAD involving the aortic arch in HRP.
• To evaluate the feasibility and outcomes of aortic debranching followed by endovascular exclusion.

Main Methods:

• Twenty-nine HRP with TAAD involving the aortic arch underwent endovascular exclusion.
• Procedures included total-arch or hemi-arch transposition (aortic debranching) followed by stentgraft placement.
• Various endografts were used, with banding techniques in some cases.

Main Results:

• Surgical transpositions were successful, with a 3.5% stroke rate. Endovascular procedures were performed in 96.3% of cases.
• Catheterization-related complications occurred in 7.7% of patients (iliac rupture, left ventricle perforation).
• Follow-up showed recirculation in 13.3% of aneurysms and 27.3% of dissections; one late death from respiratory failure.

Conclusions:

• Secondary endovascular exclusion of aortic arch TAAD in HRP is feasible with preliminary aortic debranching.
• Total-arch transposition is beneficial for uncertain proximal neck lengths or potential arch embolization.
• Mid-term results are encouraging, but careful monitoring for aortic recirculation and enlargement is crucial.