Suitability Analysis of 2 Devices for Endovascular Aortic Arch Repair Following Type A Aortic Dissection Surgery

Endovascular aortic arch repair (Ar-TEVAR) may be a viable option for patients with residual arch pathology after surgery for type A acute aortic dissection (ATAAD). However, anatomical limitations can hinder its suitability. The primary outcome of this retrospective, dual-centre study aimed to assess the suitability of Ar-TEVAR using 2 branched devices in patients with prior ATAAD repair.

Patients who underwent surgery for ATAAD at 2 centres between January 2012 and September 2023 were evaluated. The inclusion criteria were prior surgery limited to ascending and/or hemiarch replacement and the availability of a high-quality predischarge computed tomography (CT) scan. Two independent physicians analysed the CT scans to assess suitability for the single-branch NEXUS Aortic Arch Stent Graft System and the double-branch RelayBranch Thoracic Stent-Graft System, based on manufacturers' specifications.

Of 465 patients who underwent surgery for ATAAD, 119 (25.6%) were included. Overall, Ar-TEVAR was feasible in 59 patients (49.6%). Device-specific suitability rates were 31.9% for Nexus and 35.3% for RelayBranch, with only 21 patients (17.6%) eligible for both. An inadequate proximal landing zone, often due to surgically modifiable factors such as a too-short or kinked ascending graft, was the primary reason for ineligibility in 48.1% of Nexus cases and 68.8% of RelayBranch cases.

Approximately half of patients with residual aortic arch pathology after ATAAD surgery are eligible for Ar-TEVAR with Nexus and RelayBranch systems. Surgically modifiable factors at the time of the index procedure frequently contribute to ineligibility, highlighting the need for surgical strategies that optimize future endovascular options.