Takao Ohki, Yuji Kanaoka, Koji Maeda, Kenjirou Kaneko, Hiromasa Tachihara
Surgery, Jikei University, Minato-ku, Japan.
OBJECTIVES: Total arch repair (TAR) is the gold standard therapy for arch aneurysm; however, there is room for improvements. We present the outcome of our endovascular strategy for arch aneurysms.
METHODS: During the last 3 years, we performed Chimney technique (38 cases) and the retrograde in-situ branched stent grafting (RIBS, 7 cases) to treat 45 patients with arch aneurysms, all of whom were considered to be at high risk for TAR. The chimney technique involves a uni- or bilateral common carotid artery exposure and insertion of a small diameter covered stent to preserve cerebral flow in conjunction with the deployment of the main endograft in the ascending aorta. The RIBS method was developed in an aim to reduce gutter endoleak associated with the Chimney technique. The RIBS procedure is performed by puncturing the main endograft in a retrograde manner and followed by balloon dilatation and covered stent deployment.
RESULTS: The mean aneurysm diameter (short axis) was 6.6cm. The overall OR time was 318+/-126 minutes and blood loss was 703+/-730ml and 12 (26%) patients required blood transfusion. Endoleak was encountered in 3 (7.9%) cases and all were among the Chimney patients as a result of gutter EL. There were no cases with endoleak among the RIBS patients. There was one mortality (2.2 %) that resulted from intraoperative retrograde type A dissection. Stroke occurred in 1 case (2.2%), but it was minor and resolved completely. Combined stroke death rate was 4.4%. During a mean FU of 11.2+/-6.9 months, no aneurysm rupture has been encountered.
CONCLUSIONS: Both the Chimney technique and the RIBS procedure are safe and effective and can be considered as an alternative option for those patients unfit for TAR. RIBS appear to be advantageous in further eliminating gutter endoleak.
AUTHOR DISCLOSURES: Y. Kanaoka: Nothing to disclose; K. Kaneko: Nothing to disclose; K. Maeda: Nothing to disclose; T. Ohki: Nothing to disclose; H. Tachihara: Nothing to disclose.
Posted April 2013