[Surgical strategy for extended aortic arch aneurysm].

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Thoracic Surgery

Context:

• Extended aortic arch aneurysms present significant management challenges.
• Open surgical repair can be highly invasive, especially for patients with comorbidities.
• Hybrid approaches combining open surgery and thoracic endovascular aneurysm repair (TEVAR) have emerged.

Purpose:

• To evaluate and compare the outcomes of various surgical techniques for extended aortic arch aneurysms.
• To assess the efficacy and safety of hybrid TEVAR strategies versus traditional open repair.
• To identify optimal treatment pathways based on patient risk and aneurysm characteristics.

Summary:

• This study analyzed 241 patients with non-dissection aortic arch aneurysms treated between 1997 and 2013.
• Techniques included open repair, frozen elephant trunk (FET), long elephant trunk (LET) with TEVAR, and debranched TEVAR.
• Debranched TEVAR showed high initial rates of brain infarction and in-hospital mortality, but outcomes have improved with experience.

Impact:

• Open repair remains the gold standard, but hybrid TEVAR is a viable option for high-risk individuals.
• The study highlights the evolving landscape of aortic arch aneurysm management towards less invasive hybrid techniques.
• Off-pump debranched TEVAR is increasingly considered for complex extended arch aneurysms.