Aortic arch debranching and thoracic endovascular repair

The authors reviewed their experience with 104 consecutive patients who underwent elective arch treatment with debranching and thoracic endovascular aortic repair between 2005-2013.  Major complications at 30 days (death, stroke, and spinal cord ischemia) occurred in 6, 4, and 3 patients, respectively. At 1, 3, and 5 years survival rates were 89.0%, 82.8%, and 70.9%. Extension to ascending aorta (zone 0 landing) was the only multivariate independent predictor for perioperative mortality. Freedom from persistent endoleak was 96.1%, 92.5%, and 88.3% at 1,3, and 5 years. The authors conclude that the endovascular aortic arch repair presents a low rate of aorta-related deaths and reinterventions and acceptable midterm survival.  One-third of the aneurysms decreased in diameter over 5 years. Retrograde type A dissection remains a major concern in the perioperative period.