Midterm outcome of supra-aortic vessels reconstruction: A single-center report

The treatment of complex aortic arch pathologies demands the reconstruction (endovascular or surgical) of 1 or multiple supra-aortic vessels to restore the blood flow of these vessels during thoracic endovascular aortic repair. However, the patency and fate of the endovascular bypass remain unclear. This report compares the midterm outcome of endovascular versus surgical bypass in thoracic endovascular aortic repair.

Between 2007 and 2015, 395 patients underwent thoracic endovascular aortic repair at our institution. Only thoracic endovascular aortic repairs landing proximally at landing zones zero, 1, and 2 were included (244/395). We recorded the type of bypass method used (endovascular or surgical) and the number of supra-aortic vessels bypassed.

The median follow-up was 4.1 years. Aortic dissection, thoracic aortic aneurysm, and traumatic aortic injury were the most common indications for thoracic endovascular aortic repair. Endovascular bypass was more commonly used in thoracic endovascular aortic repair landing proximally at zone 1. The 30-day postoperative mortality rate was 11% (25 patients), but it was not different among both methods. Six patients (10.5%) in the endovascular group and 27 patients (16.5%) in the surgical bypass group needed reintervention. The late survival and adverse events were similar. Postoperative stroke occurred in 15 patients (6.8%). Type Ia endoleak was more common after endovascular bypass (17 patients, 36.2%), but this was not statistically significant.

In our report, with a tailored approach, the endovascular reconstruction of the supra-aortic vessels was not inferior to the surgical approach and had an acceptable patency rate at mid follow-up with a low rate of complications after surgery.