Supra-aortic Transposition for Combined Vascular and Endovascular Repair of Aortic Arch Pathology

摘要: Background Supra-aortic transpositions in various extents followed by endovascular stent graft placement are now an established tool the treatment of pathologies affecting aortic arch. Results remain to be determined. Methods From 1996 through 2007, 73 patients (median age, 71 years) presented with arch pathology (atherosclerotic aneurysms, n=42; type B dissections, n=9; penetrating ulcers, n=17; traumatic lesions, n=2; aneurysms based on prior surgery for coarctation, n=3). Strategy distal disease was subclavian-to-carotid transposition (n = 24) or autologous double-vessel upper hemisternotomy 36). For entire disease, total supra-aortic rerouting a reversed bifurcated prosthesis applied 13). Endovascular performed metachronously. In-hospital mortality 6.8% 5). Persistent early I and III endoleak rate 9.6%. late 5.5%. Overall actuarial survival 90%, 86%, 72% at 1, 3, 5 years. Mean follow-up is 37 months (range, 1 120). Early formation independently predicted number prostheses (early odds ratio [OR] 0.210, p 0.0003; OR 0.216, 0.012), whereas logistic EuroSCORE (European System Cardiac Operative Risk Evaluation) reached borderline significance regarding endoleaks (OR 2.1, 0.095). An earlier year implantation predicting 1.9, 0.062). Furthermore, higher levels 1.8, 0.020). Interestingly, did not influence 0.9, 0.812). Conclusions after promising. Endoleak directly related may reduced longer devices. Each rerouting, irrespective extent, has turned out effective. Therefore, extended applications these combined strategies substantially augment therapeutic options.