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Comparison of Total Arch and Partial Arch Transposition During Hybrid Endovascular Repair for Aortic Arch Disease

Authors
 W.C. Kang  ;  Y.-G. Ko  ;  P.C. Oh  ;  E.K. Shin  ;  C.-H. Park  ;  D. Choi  ;  Y.N. Youn  ;  D.Y. Lee 
Citation
 EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol.52(2) : 173-178, 2016 
Journal Title
 EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 
ISSN
 1078-5884 
Issue Date
2016
MeSH
Aged ; Aorta, Thoracic/surgery* ; Aortic Arch Syndromes/mortality ; Aortic Arch Syndromes/surgery* ; Blood Vessel Prosthesis ; Endoleak/etiology ; Endovascular Procedures ; Female ; Humans ; Male ; Middle Aged ; Reoperation ; Retrospective Studies ; Stents ; Stroke/etiology ; Vascular Grafting/adverse effects ; Vascular Grafting/methods ; Vascular Grafting/mortality
Keywords
Hybrid endovascular repair ; Mortality ; Partial arch transposition ; Re-intervention ; Stent graft ; Total arch transposition
Abstract
OBJECTIVE: Total arch transposition (TAT) during hybrid endovascular repair for aortic arch disease is believed to allow a better landing zone, but also to be associated with higher peri-operative mortality than partial arch transposition (PAT). Information on this issue is limited. METHOD: This study was a retrospective analysis. All 53 consecutive patients with aortic arch disease (41 males, mean age 65.0 years) who underwent hybrid endovascular repair with TAT (zone 0, n=20) or PAT (zone 1 or 2, n=33) from 2008 to 2014 were analyzed retrospectively. The peri-operative and late outcomes of these two groups were compared. RESULTS: Baseline characteristics, including EuroSCORE II results, were similar in the two groups. After procedures, peri-operative mortalities and stroke rates were similar in the two groups (5.0% vs. 9.1%, p=1.000, and 10.0% vs. 6.1%, p=.627). Interestingly, all four strokes occurred in patients with a type III aortic arch irrespective of transposition type. Primary success rates (80.0% vs. 69.7%, p=.527) and type I endoleak incidences (20.0% vs. 27.3%, p=.744) were not significantly different. During follow up (mean duration 36.9 months), overall survival (89.7% vs. 87.4% at 1 year and 89.7% vs. 79.3% at 3 years; p=.375) and re-intervention free survival rates (78.6% vs. 92.0% at 1 year; 72.0% vs. 62.2% at 3 years, p=.872) were similar in the two groups. CONCLUSION: Morbidity and mortality were high within the first year of hybrid endovascular therapy for aortic arch disease, implying that candidates for hybrid procedures need to be selected carefully. Hybrid endovascular repair with TAT was found to have peri-operative mortality, stroke, and long-term survival rates comparable with PAT, so hybrid endovascular repair may be considered, irrespective of type of arch reconstruction, when clinically indicated.
Full Text
http://www.sciencedirect.com/science/article/pii/S1078588416301691?via%3Dihub
DOI
10.1016/j.ejvs.2016.06.001
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Youn, Young Nam(윤영남)
Lee, Do Yun(이도연)
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/152413
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