Paola De Rango2, Ciro Ferrer1, Carlo Coscarella1, Gioele Simonte2, Enrico Cieri2, Luca Farchioni2, Fabio Verzini2, Gianbattista Parlani2, Piergiorgio Cao1
1Vascular Surgery, Hospital S Camillo Forlanini, Rome, Italy; 2Vascular and Endovascular Surgery; University of Perugia, Hospital S.M.Misericordia, Perugia, Italy.
OBJECTIVES: To evaluate early and five years results of partial or total arch debranching.
METHODS: In 2001-2012, 100 consecutive patients underwent elective hybrid arch repair with debranching and stent graft (TEVAR). Outcomes were stratified for extension of arch involvement. Primary outcomes were perioperative (30-day) and five years mortality.
RESULTS: Mean patient age was 70.1 years, and 88 were males. Sixteen arches were repaired for dissection. Twenty patients required total debranching for diseases extended to Zone-0. In 55, debranching and TEVAR procedures were staged. At 30-day, death, stroke and paraplegia occurred in 6, 4 and 3 patients, respectively. In 80, requiring partial debranching, the same outcome rates were 2.5%, 3.8% and 2.5%, respectively. In patients with dissections, there was no death, paraplegia or stroke. Extension to ascending aorta requiring total arch debranching was the only multivariate independent predictor for mortality (odds ratio, 11.4; 95% Confidence Interval 1.91-68.4; P=.008), but not for stroke or paraplegia. One retrograde dissection with successful repair occurred after total debranching. Kaplan-Meier estimates of survival at 1, 3 and 5 years were 85.8%, 81.4% and 69.7%. Two reinterventions for endoleak were required, and no migration or late aneurysm related mortality was recorded.
CONCLUSIONS: The incidence of stroke is acceptable after both total and partial arch debranching. Total debranching is an important predictor for mortality. Retrograde dissection may be infrequent complication with careful arch approach. After the perioperative interval, debranching is a safe and durable procedure up to 5 years.
AUTHOR DISCLOSURES: P. Cao: Nothing to disclose; E. Cieri: Nothing to disclose; C. Coscarella: Nothing to disclose; P. De Rango: Nothing to disclose; L. Farchioni: Nothing to disclose; C. Ferrer: Nothing to disclose; G. Parlani: Nothing to disclose; G. Simonte: Nothing to disclose; F. Verzini: Nothing to disclose.
Posted April 2013