Complex Cervical Debranching During Thoracic and Arch Endovascular Aortic Repair is Associated with Increased Risks...

Cervical debranching (CD) of supra-aortic trunk (SAT) vessels is increasingly used to extend proximal seal zone during thoracic endovascular aortic repair (TEVAR). Prior research has focused on left subclavian artery revascularization during zone 2 TEVAR, and there are limited data on outcomes of more complex CD. We provide a comparative analysis of outcomes between standard CD and complex CD during TEVAR.

A retrospective review of patients who underwent CD with TEVAR at a regional aortic center was performed. Patients were grouped based on the type of CD operation. Standard CD were defined as operations involving a unilateral subclavian or axillary artery, and complex CD were operations involving multiple SAT vessels and/or aberrant arch anatomy. The primary endpoint was local complications within 30 days. Secondary endpoints included graft patency, reintervention, major adverse events, and survival. Outcomes were compared between groups.

A total of 82 patients were included (63 standard CD, 19 complex CD). Local complications occurred more frequently after complex CD (52.6% vs. 25.4%, P = 0.025), as did major adverse events (57.9% vs. 28.6%, P = 0.019) and 30-day mortality (21.1% vs. 3.2%, P = 0.009). At mean follow-up of 465 days, there was no difference in target vessel patency. Patients in complex CD group had greater need for reintervention (47.4% vs. 17.5%, P = 0.018). Kaplan-Meier 1-year survival probability was higher for standard CD (90% vs. 69%, log-rank P = 0.038).

Complex CD is associated with an increased risk of local complications, major adverse events, reintervention, and early mortality. These results suggest a potential benefit for ongoing advancement of SAT incorporation techniques during TEVAR.