Endovascular aortic arch repair with three-vessel inner branches is safe, investigators find

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Arch repair

Total endovascular aortic arch repair for aneurysms and chronic dissections using three-vessel inner branch stent-grafts is technically feasible and safe, a multicenter global early feasibility study finds.

“Mortality and stroke rates compare favorably to reported outcomes of total open surgical arch replacement, particularly among higher risk patients who had prior median sternotomies and ascending aortic repairs,” Emanuel R. Tenorio, MD, aortic research fellow at the Mayo Clinic in Rochester, Minnesota, et al report. Tenorio will deliver the findings in a scientific session on June 30.

The research team had sought to evaluate outcomes of endovascular repair using the three- vessel inner branch method. They reviewed clinical data and outcomes of consecutive patients treated by way of total endovascular aortic arch repair at eight academic centers over from 2016–2019.

They explain: “All patients received patient- specific stent designs with two antegrade and one retrograde inner branch, which was used to incorporate the innominate (IA), left common carotid (LCCA) and left subclavian arteries (LSA). The antegrade inner branches were accessed via axillary or carotid artery access.

“A preloaded catheter was used for access to the retrograde LSA branch via femoral approach. End-points were technical success, mortality, major adverse events (MAEs), any stroke (minor or major) or transient ischemic attack (TIA), secondary interventions, target vessel patency, target vessel instability, aneurysm-related mortality and patient survival.”

A total of 39 patients—31 of them male (79%) and with a mean age of 70 (±7)—were treated for 14 (36%) degenerative and 25 (64%) chronic post-dissection arch aneurysms. Clinical characteristics included American Society of Anesthesiologist (ASA) classification >3 in 37 patients (95%) and prior median sternotomy for ascending aortic repair in 33 patients (85%), Tenorio et al find. Technical success rate was 100%, the investigators say. “This multicenter global experience demonstrates the technical feasibility and safety of total endovascular aortic arch repair for aneurysms and chronic dissections using three-vessel inner branch stent-grafts,” the authors conclude.

WHEN: Tuesday, June 30, 2020, 6:30 p.m.–6:42 p.m. Scientific Session 6

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