Branched Endografts in the Aortic Arch Following Open Repair for Debakey Type I Aortic Dissection

Background: DeBakey Type I aortic dissections are frequently treated by an ascending aortic tube-graft or hemiarch replacement with the residual dissection remaining untreated. We investigate the outcomes of branched thoracic endovascular repair (b-TEVAR) for post-dissection-aneurysms of the aortic arch.

Methods: Retrospective, single-center evaluation of 20 consecutive patients with false lumen aneurysm after DeBakey I aortic dissection treated with b-TEVAR. The indication for endovascular repair was consented in an interdisciplinary case conference. Study endpoints were technical success, 30-day mortality and complications as well as late complications and reinterventions.

Results: Between 2012 and 2016, twenty patients (14 males, age 65 ± 9 years) were treated for false lumen aneurysm formation after DeBakey Type I aortic dissection. All patients had undergone open ascending aortic repair either isolated (n = 16) or with partial arch repair (n = 4). Technical success was achieved in 19 of 20 cases. 30-day mortality and stroke incidence were both each 5% (1/20). Simultaneous procedures to exclude false lumen perfusion included implantation of a knickerbocker graft in 3 patients (15%) and of a candy-plug graft in 7 patients (35%). Early postoperative CTA revealed persistent false lumen perfusion in 10 cases that required secondary interventions in 6 cases. During 17 ± 14 months of mean follow-up there was one aortic-related death and two deaths from non-aortic reasons. Estimated overall survival was 89 ± 7% and 75 ± 15% at 12 and 36 months respectively.

Conclusion: Treatment of residual aortic arch dissections with b-TEVAR appears feasible and safe with low mortality and stroke rates. A high rate of secondary procedures is required to achieve thoracic false-lumen occlusion.