Objectives: DeBakey type I aortic dissections are frequently treated by a short ascending aorta and aortic valve repair with the rest of the dissection remaining untreated and often progressing to aortic arch aneurysm formation during later follow-up. We aim to investigate the outcomes of fenestrated-branched endografts (FBSG) for postdissection aneurysms of the aortic arch. Methods: Retrospective, single center evaluation of all consecutive patients with residual DeBakey type I aortic arch dissection treated with FBSG in our institution. End points were technical success, 30-day mortality and complications, and late complications and reinterventions. Results: Between 2012 and 2015, 49 patients were treated with FBSG in the aortic arch. Twelve patients (6 male; age, 65 +/- 10 years) were treated for dissecting aneurysms of the aortic arch (11 post-DeBakey type I aortic dissection aneurysms and 1 for an acute type I aortic dissection). Eleven of 12 patients had prior open ascending aortic repair or partial arch repair, and one patient had only prior aortic valve repair and acute AAD that was treated by an ascending endograft plus arch branch device. Therapy involved implantation of a fenestrated endograft in 1 case and of branched arch endografts in 11 cases. All patients had prior cervical debranching procedures, including left-sided carotid-subclavian bypass (n = 11), axilloaxillary bypass (n = 1) and right-sided carotid-subclavian bypass (n = 2). Technical success was achieved in all cases. There was no operative or 30-day mortality (0%) as well as no neurologic complications (stroke/paraplegia, 0%). There were two minor access complications (1 pseudoaneurysm of a brachial artery and a dissection of the common carotid artery requiring patch angioplasty). Postoperative computed tomography angiography revealed five persisting false lumen perfusions that required reinterventions to extend the repair distally or occlude retrograde false lumen reperfusion in five cases. No aneurysm expansion or aneurysm rupture was observed at 13 months of mean follow-up (range, 3-24 months), but two patients died of reasons unrelated to the aortic aneurysm. Conclusions: Treatment of residual aortic arch dissections with FBSG appears feasible and safe with no deaths or strokes in this series in the presence of a graft interposition in the descending aorta. A high number of reinterventions in local anesthesia is required to achieve false-lumen occlusion in these patients but the technique offers a valid alternative to open reoperation in this high-risk population. (figure present).
Tsilimparis, N., Debus, E. S., Saleptsis, V., Wipper, S., Rohlffs, F., & Kölbel, T. (2016). FT19. Fenestrated-Branched Endografts for Aortic Arch Dissection Aneurysms. Journal of Vascular Surgery, 63(6), 23S. https://doi.org/10.1016/j.jvs.2016.03.201