Fate of the Aortic Arch After Open Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repair

This study aimed to evaluate the fate of the untreated aortic arch after descending thoracic and thoracoabdominal aortic aneurysm (DTA/TAAA) repair.

We retrospectively reviewed patients who underwent open DTA/TAAA repair between January 1991 and April 2025. The analysis included those with proximal anastomosis to the descending thoracic aorta (DTA extent A/C and TAAA extent I/II patients). Patients with prior arch replacement were excluded. This also applied to patients who had undergone arch repair as the first stage of a planned staged approach before subsequent DTA/TAAA repair.

Of 2227 patients who underwent open DTA/TAAA repair, 1355 had procedures classified as DTA extent A/C or TAAA extent I/II. After exclusion of 179 patients with prior arch replacement, 1176 were included in the analysis (DTA A, 20.9%; DTA C, 25.9%; TAAA I, 25.9%; TAAA II, 25.9%). Operative mortality was 17.0% (n = 200). Early spinal cord injury occurred in 3.1% and delayed in 5.7%. With a median follow-up of 2.5 years (0.1-7.6 years), 5-year and 10-year survival rates were 55.8% and 35.4%, respectively. Aortic arch reintervention, including both open arch replacement and endovascular aortic arch repair, was performed in 23 patients (1.9%). The 10-year freedom from arch reoperation was 95.9%. Patients with residual dissection in the arch had a significantly lower freedom from arch reintervention compared with those without (10-year: 90.3% vs 97.3%; P < .001).

With appropriate selection of patients, reintervention on the aortic arch after open DTA/TAAA repair was infrequent. Although patients with residual dissection in the arch had a higher risk of late arch reoperation, the 10-year incidence was approximately 10%, suggesting that routine prophylactic intervention on the aortic arch may not be necessary.