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Non-Standard Management of Target Vessels With the Inner Branch Arch Endograft: A Single-Center Retrospective Study
Jose I Torrealba1,2,3, Konstantinos Spanos1,4, Giuseppe Panuccio1
1Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center of Hamburg, Hamburg, Germany.
Insights
The inner branch arch endograft offers a viable option for non-standard supraaortic vessel management. Despite a high reintervention rate, this approach achieved aneurysm stability or regression in all patients.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortic Disease Management
Background:
- Non-standard management of supraaortic target vessels presents unique challenges in aortic repair.
- Inner branch arch endografts are emerging as a potential solution for complex aortic arch pathologies.
Purpose of the Study:
- To evaluate the early and mid-term outcomes of using an inner branch arch endograft for non-standard management of supraaortic target vessels.
- To assess technical success, mortality, reinterventions, endoleaks, and aortic remodeling in this patient cohort.
Main Methods:
- A single-center retrospective study included patients treated with an inner branch arch endograft from December 2012 to March 2021.
- Focus was on patients with non-standard supraaortic vessel management, including bypasses other than left carotid-subclavian or landing in dissected vessels.
- Outcomes analyzed included technical success, mortality, reinterventions, endoleak, and aortic remodeling.
Main Results:
- Twenty-four patients were analyzed, with innominate artery compromise being the most common indication (71%).
- Perioperative complications included minor strokes (8%) and one death (4%).
- Seven patients required reinterventions, primarily for false lumen perfusion and endoleaks, but all patients achieved aneurysm stability or regression without growth at follow-up.
Conclusions:
- The inner branch arch endograft is a feasible option for non-standard supraaortic vessel management.
- While reintervention rates are notable, the technique effectively controls aneurysm progression.
- This approach demonstrates promising results for complex aortic arch cases.
Purpose:
The purpose of this study was to evaluate early and mid-term results of non-standard management of the supraaortic target vessels with the use of the inner branch arch endograft in a single high-volume center.
Material And Methods:
A single-center retrospective study including all patients undergoing implantation of an inner branch arch endograft from December 2012 to March 2021, who presented a non-standard management of the supraaortic target vessels (any bypass other than a left carotid-subclavian or landing in a dissected target vessel). Technical success, mortality, reinterventions, endoleak (EL), and aortic remodeling at follow-up were analyzed.
Results:
Twenty-four patients were included. In 17 (71%) cases, the non-standard management was related to innominate artery (IA) compromise (12 with IA dissection, 2 with short IA, 2 with short proximal aortic landing zone that required occlusion of IA, 1 with occluded IA after open arch repair). Two (8%) cases were related to an aberrant right subclavian artery (RSA), 1 patient (4%) due to the concomitant presence of a left vertebral artery (LVA) arising from the arch and an occluded left subclavian artery (LSA), and another patient presented with an occluded LSA distal to a dominant vertebral artery. Three (13%) cases were exclusively related to management in patients with genetic aortic syndromes. Twenty (83%) patients had a previous type A aortic dissection. Ten (42%) patients presented a thoracic or thoracoabdominal aortic aneurysm and 8 (33%) patients an arch aneurysm, 6 of them associated to false lumen (FL) perfusion. There were 2 (8%) perioperative minor strokes, and 1 patient with perioperative mortality. Seven patients presented an early type I endoleak, all resolved at follow-up. Seven patients required reinterventions during follow-up (7 reinterventions related to continuous false lumen perfusion, 3 related to Type Ia endoleak, 2 related to surgical bypass). All patients who presented with FL perfusion had complete FL thrombosis at follow-up. No patient presented aneurysm growth at follow-up.
Conclusions:
The use of the inner branch arch endograft with a non-standard management of the supraaortic target vessels is a possible option. Despite a high reintervention rate, regression or stability of the aneurysmal diameter was achieved in all the patients with follow-up.
