Developments in parallel grafts for aortic arch lesions

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Endovascular Repair

Background:

• Shortage of off-the-shelf aortic arch grafts necessitates alternative solutions.
• Parallel grafts and chimney grafts are increasingly utilized for aortic arch lesions.
• Existing techniques face challenges with type I endoleaks and graft-to-graft sealing.

Purpose of the Study:

• To evaluate the outcomes of using Medtronic thoracic grafts with long self-expanding parallel grafts for aortic arch repair.
• To assess the efficacy and safety of parallel and chimney graft configurations in complex aortic arch interventions.

Main Methods:

• Retrospective analysis of 65 parallel grafts placed into supra-aortic branches.
• Utilization of chimney grafts in the carotid (21 cases) and left subclavian arteries (36 cases).
• Application of sandwich configurations and ensuring >7 cm overlap between grafts.

Main Results:

• Patency rates were 69% for subclavian artery chimney grafts and 73% for carotid artery parallel grafts.
• A stroke rate of 5.2% was observed.
• Primary type I endoleak rate was 28%, with 25% requiring secondary interventions.

Conclusions:

• Parallel and chimney grafts offer a viable endovascular solution for aortic arch lesions.
• High rates of type I endoleaks and neurological complications require further investigation and optimization.
• Further research is needed to mitigate risks and improve sealing in complex aortic arch interventions.