P-064 - TOTAL ENDOVASCULAR ARCH REPAIR IN PATIENTS TURNED DOWN FOR OPEN SURGICAL REPAIR

TOPIC:
Thoraco-abdominal Aortic Disease
AUTHORS:
Gormley S. (Waikato Hospital New Zealand ~ Hamilton ~ New Zealand) , Zaman Z. (Waikato Hospital New Zealand ~ Hamilton ~ New Zealand) , Khashram M. (Waikato Hospital New Zealand ~ Hamilton ~ New Zealand)
Introduction:
Open surgical repair is the "gold standard" for most aortic arch diseases. However there is a subgroup of high risk patients who benefit from a total endovascular solution. Total endovascular arch repair is a strategy that can circumvent the morbidity and mortality associated with open total arch replacement particularly those not suitable for revision arch surgery. The objective of this study was to evaluate the early outcomes of aortic arch disease treated by this approach.
Methods:
This is a retrospective study of all patients who were declined re-do arch surgery in our institution between December 2020 to December 2021. Indications for therapy involved degenerative aortic arch dissection aneurysms, aortic dissections involving the arch and ruptured aortic arch aneurysms. All patients had a previous type A aortic dissection repaired by open surgery and were now considered too high risk for re-do arch surgery. Study end points were technical success, 30-day mortality, and complications as well as late complications and re-interventions.
Results:
Between December 2020 to December 2021 there were 7 patients (4 male; median age 56 years) treated. 5 underwent supra-aortic de-branching and 3 cases involved temporary external bypass procedures(carotid- femoral or axillary-femoral). 3 patients had a branch arch device, 2 had a ChEVAR and 2 had multiple TEVAR stents involving chimney grafts. No retrograde aortic dissections observed or conversions to open surgery. There were no deaths at 30 days. One patient had a major stroke post open AAA repair resulting in death 5 months post arch branch device insertion. One patient developed transient spinal cord ischaemia that had resolved after spinal fluid drainage. No episodes of renal failure or permanent paraplegia observed. All patients discharged home. Follow up imaging demonstrated persistent adequate exclusion of aortic arch pathology.
Conclusion:
Total endovascular solutions provide a safe and feasible alternative to open repair with acceptable short and midterm results. Long term follow up is essential to assess the benefits of this approach in carefully selected patients.