Endovascular debranching of the aortic arch during XXXX endograft repair.

@entity1 @entity697 @entity64 @entity1514 @entity439 @entity292 @entity583 @entity204 @entity1756
BACKGROUND: Treatment of complex @entity1514 aortic pathology increasingly requires coverage of one or more aortic arch vessels. Endovascular debranching with a chimney technique can reduce or eliminate the need for surgical bypass. In this study, we evaluate our initial experience with planned endovascular debranching of the aortic arch. METHODS: During a 13-month period, nine @entity1 were treated with endovascular debranching during @entity1514 endograft placement. Balloon expandable (n = 7) or self-expanding stents (n = 2) were deployed (innominate, n = 2; left common carotid, n = 2; left subclavian, n = 5) along with either TAG (W. L. Gore, Flagstaff, Ariz; n = 8) or Talent (Medtronic, Minneapolis, Minn; n = 1) endografts. Four @entity1 required six surgical bypasses to additional arch vessels (right to left common carotid artery, n = 2; left common carotid to subclavian artery, n = 4). RESULTS: Indications for @entity1514 endograft placement were aortic transection (n = 4), aortic @entity439 (n = 2), aortotracheal @entity292 (n = 1), contained aortic @entity1756 (n = 1), and @entity697 (n = 1). Endografts were deployed into zones 0 (n = 2), 1 (n = 2), and 2 (n = 5). Technical success of endovascular debranching was attained in eight of nine @entity1 , with maintenance of branch perfusion and absence of endoleak. Perioperative morbidity included one @entity583 and one @entity64 that resulted in the @entity1 's @entity204 . During subsequent follow-up (range, 2-25 months), there were no instances of endoleak secondary to chimney stents. All debranched vessels maintained primary patency. CONCLUSION: Endovascular debranching permits planned extension of the @entity1514 endograft over arch vessels while further minimizing the need for open reconstruction. Short-term results indicate technical feasibility of this approach. Long-term outcomes remain undefined.
