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Multicenter Comparison of Aortic Arch Aneurysms and Dissections Zone 0 Hybrid and Total Endovascular Repair

  • Clinical Investigation
  • Arterial Interventions
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Abstract

Purpose

Comparison of hybrid and total endovascular aortic arch repair at two tertiary vascular surgery centers.

Materials and Methods

Consecutive patients undergoing hybrid (HG) or total endovascular (TEG) total aortic arch repair for aneurysms or dissections were included (2008–2022). Primary outcome measure was 30-day mortality. Secondary outcomes were major complications, technical success (defined as absence of surgical conversion/mortality, high-flow endoleaks or branch/limb occlusion), clinical success (defined as absence of disabling clinical sequelae), late and aortic-related mortality/reinterventions, freedom from endoleaks, aortic diameter growth > 5 mm, graft migration and supra-aortic trunks (SAT) patency.

Results

In total, 30 patients were included, 17 in HG and 13 in TEG. TEG presented shorter intervention time (240.5 vs 341 min, p = 0.01), median ICU stay (1 vs 4.5 days, p < 0.01) and median length of stay (8 vs 17.5 days, p < 0.01). No intraoperative deaths occurred. Technical success was 100%; clinical success was 70.6% in HG and 100% in TEG (p = 0.05). Thirty-day mortality was 13.3%, exclusively in HG (p = 0.11). Nine major complications occurred in 8 patients, 5 in HG and 3 in TEG (p = 0.99), among which five strokes, two in HG and three in TEG (p = 0.62). Late mortality was 38.5%, six patients in HG and four in TEG, p = 0.6. Two late aortic-related deaths occurred in HG (p = 0.9). Two aortic-related reinterventions, no graft migration or SAT occlusion was observed.

Conclusions

Total endovascular repair seems to shorten operative times and provide higher clinical success compared with hybrid solutions, without significant 30-day mortality differences. The most common major complication is stroke.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Vascular and Endovascular Surgery Unit, S. Croce e Carle Hospital, Via Coppino 26, 12100, Cuneo, Italy

    Edoardo Frola, Lorenzo Mortola, Dimitrios Apostolou & Massimo Maione

  2. Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy

    Emanuele Ferrero, Michelangelo Ferri, Simone Quaglino & Andrea Gaggiano

Authors
  1. Edoardo Frola
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  2. Lorenzo Mortola
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  3. Emanuele Ferrero
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  4. Michelangelo Ferri
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  5. Dimitrios Apostolou
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  6. Simone Quaglino
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  7. Massimo Maione
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  8. Andrea Gaggiano
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Correspondence to Edoardo Frola.

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M.F. is consultant for Kawasumi Lab and Penumbra Inc.

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Multicenter retrospective evaluation of zone 0 hybrid and total endovascular aortic arch repair for aneurysms or dissections in two tertiary vascular surgery centers.

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Frola, E., Mortola, L., Ferrero, E. et al. Multicenter Comparison of Aortic Arch Aneurysms and Dissections Zone 0 Hybrid and Total Endovascular Repair. Cardiovasc Intervent Radiol 46, 1674–1683 (2023). https://doi.org/10.1007/s00270-023-03607-7

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  • DOI: https://doi.org/10.1007/s00270-023-03607-7

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