Total endovascular arch repair: Initial experience in Bologna

Area of Science:

• Vascular Surgery
• Cardiovascular Research
• Medical Device Technology

Background:

• Aortic arch repair traditionally involves open surgery, which carries high risks for many patients.
• Customized fenestrated, branched, or scalloped grafts have emerged as options for aortic arch repair.
• Thoracic endovascular aortic repair (TEVAR) is an alternative for patients deemed unfit for open surgery.

Purpose of the Study:

• To evaluate the short- and long-term outcomes of total endovascular aortic arch replacement.
• To assess the feasibility of using zone 0 or zone 1 landing zones for arch TEVAR.
• To analyze survival and reintervention rates following endovascular aortic arch repair.

Main Methods:

• Retrospective analysis of patients undergoing arch TEVAR with zone 0 or zone 1 landing zones.
• Kaplan-Meier analysis for survival and freedom from reintervention.
• Review of patient demographics, procedure types, and complications.

Main Results:

• 15 high-risk patients underwent elective arch TEVAR between May 2017 and November 2023.
• Most common procedures included fenestrated endovascular aortic repair with left carotid-subclavian bypass (40%).
• 12-month survival was 87.5%, and freedom from reintervention was 85.7%, with stroke being a significant complication (13.3% perioperative).

Conclusions:

• Total endovascular aortic arch repair with custom grafts is a safe and effective option for patients with prohibitive surgical risk.
• Stroke is a notable complication requiring attention in this patient population.
• This approach offers a viable alternative to open surgery for complex aortic arch pathologies.