Efficacy and safety of debranching technique with zone 1 thoracic endovascular aortic repair in high-risk patients with distal aortic arch lesions.

BACKGROUND

To share the results of the debranching technique with zone 1 thoracic endovascular aortic repair (TEVAR) in high-risk patients chosen based on older age, cardiopulmonary comorbidities, and unfit for open surgical procedures, who have distal arch lesions.

METHODS

Between January 2020 and August 2022, 15 patients treated in our practice were treated with the debranching technique TEVAR (d-TEVAR) for distal aortic arch lesions requiring a stent-graft landing in zone 1. We retrospectively reviewed clinical data and significant outcomes for prognostic analyses. Lesion types included chronic Stanford type B aortic dissections (n = 10), distal arch aneurysms (n = 4), and one pseudoaneurysm. All lesions were chronic, with no involvement of visceral vessels. These patients were considered high-risk in a multidisciplinary fashion.

RESULTS

All procedures were completed with a technical success rate of 100%. The mean operative time was 317 ± 48 min. No in-hospital mortality or major complications were recorded. One patient had a type I endoleak at 3 months that was treated conservatively due to no symptoms during follow-up (median 16 months, (range 12-20)), and in one patient, this was associated with fatal cerebral infarction at 4 months following the procedure, yielding a stroke rate of 6.7%. Graft survival for all patients, via a Kaplan-Meier analysis, was 89.3%.

CONCLUSIONS

For distal aortic arch lesions requiring a zone 1 stent-graft landing, d-TEVAR is an effective and safe alternative treatment option with promising short-term results in well-selected high-risk patients and can be applied when open surgery constitutes a significant surgical risk.