P215. Midterm Outcome Of Supra-Aortic Vessels Reconstruction: A Single Center Report
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
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Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: The treatment of complex aortic arch pathologies demands the reconstruction (Endovascular or open) of one or multiple supra-aortic vessels to restore the blood flow of these vessels during thoracic endovascular aortic repair (TEVAR). However, the patency and fate of the endovascular bypass reminds unclear. This report aims to compare the midterm outcome of endovascular versus open bypass in TEVAR.
Methods: Between 2007 and 2015, 395 patients underwent TEVAR at our institution. Only TEVARs landing proximally at landing zones zero, one, and two were included (221/395). Endovascular bypass was selected only when a secure proximal landing zone of at least one centimeter existed. We recorded the type of bypass method that was used (Endovascular or open) and the number of supra-aortic vessels bypassed.
Results: The median follow-up was 4.1 years. Aortic dissection, thoracic aortic aneurysm, and traumatic aortic injury were the most common indication for TEVAR. Endovascular bypass was more commonly used in TEVAR landing proximally at zone 1. The thirty-day post-operative mortality was 11% (25 patients), but it was not different among both methods. Six patients (10.5%) in the endovascular group and 27 (16.5%) patients in the open bypass group needed reintervention. The late survival rate and adverse events were similar. Post-operative stroke happened in 15 (6.8%) of the patients. Bypass occlusion was the most common complications in both groups. Type Ia endoleak was more common after endovascular bypass (17 patients, 36.2%) but this was not statistically significant. Most of the type Ia endoleaks self-resolve within 3 months after TEVAR.
Conclusion: In our report, endovascular bypass of the supra-aortic vessels was not inferior to the open approach and had a good patency rate at mid follow-up with a low rate of complications after surgery. With appropriate patient selection, endovascular bypass can achieve acceptable outcomes.
Authors
Iván Alejandro De León Ayala (1), Kuo-Sheng Liu (1)
Institutions
(1) Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
Methods: Between 2007 and 2015, 395 patients underwent TEVAR at our institution. Only TEVARs landing proximally at landing zones zero, one, and two were included (221/395). Endovascular bypass was selected only when a secure proximal landing zone of at least one centimeter existed. We recorded the type of bypass method that was used (Endovascular or open) and the number of supra-aortic vessels bypassed.
Results: The median follow-up was 4.1 years. Aortic dissection, thoracic aortic aneurysm, and traumatic aortic injury were the most common indication for TEVAR. Endovascular bypass was more commonly used in TEVAR landing proximally at zone 1. The thirty-day post-operative mortality was 11% (25 patients), but it was not different among both methods. Six patients (10.5%) in the endovascular group and 27 (16.5%) patients in the open bypass group needed reintervention. The late survival rate and adverse events were similar. Post-operative stroke happened in 15 (6.8%) of the patients. Bypass occlusion was the most common complications in both groups. Type Ia endoleak was more common after endovascular bypass (17 patients, 36.2%) but this was not statistically significant. Most of the type Ia endoleaks self-resolve within 3 months after TEVAR.
Conclusion: In our report, endovascular bypass of the supra-aortic vessels was not inferior to the open approach and had a good patency rate at mid follow-up with a low rate of complications after surgery. With appropriate patient selection, endovascular bypass can achieve acceptable outcomes.
Authors
Iván Alejandro De León Ayala (1), Kuo-Sheng Liu (1)
Institutions
(1) Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
Presentation Duration
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