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Chimney Stenting Versus Surgical Debranching for Treatment of Aortic Arch Pathologies – A Propensity Matched Analysis

Published:September 02, 2022DOI:https://doi.org/10.1016/j.avsg.2022.08.010

      Abstract

      Objective

      Endovascular repair of aortic arch lesions requires revascularization of epi-aortic vessels in case of coverage. The objective of this study was to compare the outcomes of surgical bypass versus endovascular reconstruction with a chimney graft.

      Methods

      A retrospective analysis of a multicentre register between January 2005 and December 2019 was performed. A total of 127 patients were included and divided into 2 groups: TEVAR+surgical debranching (n= 72) and TEVAR+chimney stenting (n=55). Main endpoints were major neurologic sequelae and type I A endoleak. Propensity score matching was performed to analyse baseline variables related to these outcomes.

      Results

      Mean follow-up was 35,6 months for the debranching group and 34,1 for the chimney group (P= 0.65). The incidence of stroke was higher in the chimney group, although not statistically significant (7,3% vs 4,1%; P = 0.46); for both groups a wide angle between the ostium of the target vessel and the aorta and landing in Ishimaru Zone 0 were found to be the main predictors for major neurologic sequelae (P=0.002 and P=0.003 respectively). During follow-up, 9 (12,5%) Type I A endoleaks occurred in the debranching group and 12 (21,8%) in the chimney group (P = 0.14). Aortic diameter larger than 66mm and arch angle > 46° had a strong association with proximal endoleak incidence (P=0.001 and P=0.011 respectively)

      Conclusions

      Surgical debranching showed better results than chimney stenting in terms of major neurologic events incidence and Type I A endoleak, although the difference between the groups was not statistically significative. Further research with larger cohorts is needed to establish the indications for these procedures.

      Keywords

      Glossary:

      BCT (BrachioCephalic Trunk), CKD (Chronic Kidney Disease), COPD (Chronic Obstructive Pulmonary Disease), CTA (Computed Tomography Angiography), CSF (CerebroSpinal Fluid), EL (Endoleak), LCCA (Left Common Carotid Artery), LSA (Left Subclavian Artery), RCCA (Right Common Carotid Artery), SCI (Spinal Cord Ischemia), SINE (Stent Induced New Entry-tear), TEVAR (Thoracic EndoVascular Aortic Repair)
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