Clinical outcomes of aortic arch hybrid repair in a real-world single-center experience

Aortic arch aneurysmal disease remains a therapeutic challenge. For patients unsuitable for standard open surgery, hybrid repair with debranching of the supra-aortic arteries followed by thoracic endovascular grafting has been shown to be an effective solution. The aim of this study was to report th...

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Veröffentlicht in:Journal of vascular surgery 2020-09, Vol.72 (3), p.813-821
Hauptverfasser: Soares, Tony R., Melo, Ryan, Amorim, Pedro, Ministro, Augusto, Sobrinho, Gonçalo, Silvestre, Luís, Fernandes e Fernandes, Ruy, Martins, Carlos, Fernandes e Fernandes, José, Pedro, Luís Mendes
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container_end_page 821
container_issue 3
container_start_page 813
container_title Journal of vascular surgery
container_volume 72
creator Soares, Tony R.
Melo, Ryan
Amorim, Pedro
Ministro, Augusto
Sobrinho, Gonçalo
Silvestre, Luís
Fernandes e Fernandes, Ruy
Martins, Carlos
Fernandes e Fernandes, José
Pedro, Luís Mendes
description Aortic arch aneurysmal disease remains a therapeutic challenge. For patients unsuitable for standard open surgery, hybrid repair with debranching of the supra-aortic arteries followed by thoracic endovascular grafting has been shown to be an effective solution. The aim of this study was to report the clinical outcomes of a single-institution experience using hybrid aortic arch repair. The cases of all consecutive patients submitted to hybrid aortic arch repair between January 2010 and June 2018 were prospectively collected and retrospectively analyzed. The outcomes of the study were 30-day mortality, perioperative complications, 2-year survival, endoleak, and reintervention rates. A total of 35 patients with a median age of 71 years (interquartile range, 62-77 years) were submitted to hybrid aortic arch repair, with a median follow-up of 26.9 months (interquartile range, 2.4-63.6 months). Ten procedures (28.6%) were performed urgently for contained rupture. The most common etiology was degenerative (n = 14 [40.0%]). The proximal landing zones according to the Ishimaru classification were zone 2 in 20 patients (57.1%), zone 1 in 12 patients (34.3%), and zone 0 in 3 patients (8.6%). Early endoleaks were observed in six patients (17.1%), equally distributed between type I and type II. Late endoleaks were identified in 4 of 24 patients (16.7%; type I, n = 2 [8.3%]; type II, n = 1 [4.2%]; and type III, n = 1 [4.2%]). Thirty-day mortality rate was 14.3% (n = 5) with an early death rate of 8.7% (2/23) in elective cases and 30.0% (3/10) in urgent cases (odds ratio [OR], 4.93; confidence interval [CI], 0.68-35.67; P = .128). Except in one patient, 30-day mortality was associated with landing zone 0 or zone 1 (26.7% vs 5.0%; OR, 6.91; CI, 0.68-69.86; P = .141). Three patients (8.6%) suffered a postoperative stroke, and no episodes of spinal cord ischemia were observed. Two-year survival rate was 67.8% (CI, 49.4%-80.8%). Survival rates were significantly lower with increasing age (hazard ratio [HR], 1.10; CI, 1.03-1.18; P = .004), urgent procedure (HR, 4.80; CI, 1.56-14.80; P = .003), zone 0 or zone 1 (HR, 6.34; CI, 1.73-23.18; P = .001), presence of arrhythmia (HR, 3.76; CI, 1.22-11.62; P = .013), and cerebrovascular disease (HR, 4.12; CI, 1.38-12.35; P = .006). A multivariate analysis identified age (HR, 1.11; P = .047) and zone 0 or zone 1 (HR, 4.93; P = .033) as the only predictors for overall mortality. Hybrid aortic arch repair seems to be an alternative for hi
doi_str_mv 10.1016/j.jvs.2019.11.033
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For patients unsuitable for standard open surgery, hybrid repair with debranching of the supra-aortic arteries followed by thoracic endovascular grafting has been shown to be an effective solution. The aim of this study was to report the clinical outcomes of a single-institution experience using hybrid aortic arch repair. The cases of all consecutive patients submitted to hybrid aortic arch repair between January 2010 and June 2018 were prospectively collected and retrospectively analyzed. The outcomes of the study were 30-day mortality, perioperative complications, 2-year survival, endoleak, and reintervention rates. A total of 35 patients with a median age of 71 years (interquartile range, 62-77 years) were submitted to hybrid aortic arch repair, with a median follow-up of 26.9 months (interquartile range, 2.4-63.6 months). Ten procedures (28.6%) were performed urgently for contained rupture. The most common etiology was degenerative (n = 14 [40.0%]). The proximal landing zones according to the Ishimaru classification were zone 2 in 20 patients (57.1%), zone 1 in 12 patients (34.3%), and zone 0 in 3 patients (8.6%). Early endoleaks were observed in six patients (17.1%), equally distributed between type I and type II. Late endoleaks were identified in 4 of 24 patients (16.7%; type I, n = 2 [8.3%]; type II, n = 1 [4.2%]; and type III, n = 1 [4.2%]). Thirty-day mortality rate was 14.3% (n = 5) with an early death rate of 8.7% (2/23) in elective cases and 30.0% (3/10) in urgent cases (odds ratio [OR], 4.93; confidence interval [CI], 0.68-35.67; P = .128). Except in one patient, 30-day mortality was associated with landing zone 0 or zone 1 (26.7% vs 5.0%; OR, 6.91; CI, 0.68-69.86; P = .141). Three patients (8.6%) suffered a postoperative stroke, and no episodes of spinal cord ischemia were observed. Two-year survival rate was 67.8% (CI, 49.4%-80.8%). Survival rates were significantly lower with increasing age (hazard ratio [HR], 1.10; CI, 1.03-1.18; P = .004), urgent procedure (HR, 4.80; CI, 1.56-14.80; P = .003), zone 0 or zone 1 (HR, 6.34; CI, 1.73-23.18; P = .001), presence of arrhythmia (HR, 3.76; CI, 1.22-11.62; P = .013), and cerebrovascular disease (HR, 4.12; CI, 1.38-12.35; P = .006). A multivariate analysis identified age (HR, 1.11; P = .047) and zone 0 or zone 1 (HR, 4.93; P = .033) as the only predictors for overall mortality. Hybrid aortic arch repair seems to be an alternative for higher risk patients not suitable for open repair, but selection of patients is crucial and may benefit from further refinement. In this study, worse outcomes were seen in older patients and those who required more proximal landing zones.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2019.11.033</identifier><identifier>PMID: 32067880</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Age Factors ; Aged ; Aneurysm, Dissecting - diagnostic imaging ; Aneurysm, Dissecting - mortality ; Aneurysm, Dissecting - surgery ; Aortic Aneurysm, Thoracic - diagnostic imaging ; Aortic Aneurysm, Thoracic - mortality ; Aortic Aneurysm, Thoracic - surgery ; Aortic arch ; Aortic Rupture - diagnostic imaging ; Aortic Rupture - mortality ; Aortic Rupture - surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - instrumentation ; Blood Vessel Prosthesis Implantation - mortality ; Endoleak - etiology ; Endoleak - surgery ; Endovascular procedures ; Endovascular Procedures - adverse effects ; Endovascular Procedures - instrumentation ; Endovascular Procedures - mortality ; Female ; Humans ; Male ; Middle Aged ; Multimorbidity ; Portugal ; Reoperation ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Spinal cord ischemia ; Stroke ; Stroke - etiology ; Time Factors ; Treatment Outcome</subject><ispartof>Journal of vascular surgery, 2020-09, Vol.72 (3), p.813-821</ispartof><rights>2019 Society for Vascular Surgery</rights><rights>Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-94c4e095506feb30f40d49f6cf4c6648f73b440a6372348332bfb4a87cdb34963</citedby><cites>FETCH-LOGICAL-c462t-94c4e095506feb30f40d49f6cf4c6648f73b440a6372348332bfb4a87cdb34963</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jvs.2019.11.033$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32067880$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Soares, Tony R.</creatorcontrib><creatorcontrib>Melo, Ryan</creatorcontrib><creatorcontrib>Amorim, Pedro</creatorcontrib><creatorcontrib>Ministro, Augusto</creatorcontrib><creatorcontrib>Sobrinho, Gonçalo</creatorcontrib><creatorcontrib>Silvestre, Luís</creatorcontrib><creatorcontrib>Fernandes e Fernandes, Ruy</creatorcontrib><creatorcontrib>Martins, Carlos</creatorcontrib><creatorcontrib>Fernandes e Fernandes, José</creatorcontrib><creatorcontrib>Pedro, Luís Mendes</creatorcontrib><title>Clinical outcomes of aortic arch hybrid repair in a real-world single-center experience</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Aortic arch aneurysmal disease remains a therapeutic challenge. For patients unsuitable for standard open surgery, hybrid repair with debranching of the supra-aortic arteries followed by thoracic endovascular grafting has been shown to be an effective solution. The aim of this study was to report the clinical outcomes of a single-institution experience using hybrid aortic arch repair. The cases of all consecutive patients submitted to hybrid aortic arch repair between January 2010 and June 2018 were prospectively collected and retrospectively analyzed. The outcomes of the study were 30-day mortality, perioperative complications, 2-year survival, endoleak, and reintervention rates. A total of 35 patients with a median age of 71 years (interquartile range, 62-77 years) were submitted to hybrid aortic arch repair, with a median follow-up of 26.9 months (interquartile range, 2.4-63.6 months). Ten procedures (28.6%) were performed urgently for contained rupture. The most common etiology was degenerative (n = 14 [40.0%]). The proximal landing zones according to the Ishimaru classification were zone 2 in 20 patients (57.1%), zone 1 in 12 patients (34.3%), and zone 0 in 3 patients (8.6%). Early endoleaks were observed in six patients (17.1%), equally distributed between type I and type II. Late endoleaks were identified in 4 of 24 patients (16.7%; type I, n = 2 [8.3%]; type II, n = 1 [4.2%]; and type III, n = 1 [4.2%]). Thirty-day mortality rate was 14.3% (n = 5) with an early death rate of 8.7% (2/23) in elective cases and 30.0% (3/10) in urgent cases (odds ratio [OR], 4.93; confidence interval [CI], 0.68-35.67; P = .128). Except in one patient, 30-day mortality was associated with landing zone 0 or zone 1 (26.7% vs 5.0%; OR, 6.91; CI, 0.68-69.86; P = .141). Three patients (8.6%) suffered a postoperative stroke, and no episodes of spinal cord ischemia were observed. Two-year survival rate was 67.8% (CI, 49.4%-80.8%). Survival rates were significantly lower with increasing age (hazard ratio [HR], 1.10; CI, 1.03-1.18; P = .004), urgent procedure (HR, 4.80; CI, 1.56-14.80; P = .003), zone 0 or zone 1 (HR, 6.34; CI, 1.73-23.18; P = .001), presence of arrhythmia (HR, 3.76; CI, 1.22-11.62; P = .013), and cerebrovascular disease (HR, 4.12; CI, 1.38-12.35; P = .006). A multivariate analysis identified age (HR, 1.11; P = .047) and zone 0 or zone 1 (HR, 4.93; P = .033) as the only predictors for overall mortality. Hybrid aortic arch repair seems to be an alternative for higher risk patients not suitable for open repair, but selection of patients is crucial and may benefit from further refinement. In this study, worse outcomes were seen in older patients and those who required more proximal landing zones.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Aneurysm, Dissecting - diagnostic imaging</subject><subject>Aneurysm, Dissecting - mortality</subject><subject>Aneurysm, Dissecting - surgery</subject><subject>Aortic Aneurysm, Thoracic - diagnostic imaging</subject><subject>Aortic Aneurysm, Thoracic - mortality</subject><subject>Aortic Aneurysm, Thoracic - surgery</subject><subject>Aortic arch</subject><subject>Aortic Rupture - diagnostic imaging</subject><subject>Aortic Rupture - mortality</subject><subject>Aortic Rupture - surgery</subject><subject>Blood Vessel Prosthesis</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - instrumentation</subject><subject>Blood Vessel Prosthesis Implantation - mortality</subject><subject>Endoleak - etiology</subject><subject>Endoleak - surgery</subject><subject>Endovascular procedures</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - instrumentation</subject><subject>Endovascular Procedures - mortality</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multimorbidity</subject><subject>Portugal</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Spinal cord ischemia</subject><subject>Stroke</subject><subject>Stroke - etiology</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kDtPwzAUhS0EglL4ASzII0vCdew4sZhQxUtCYgExWo5zTV2lcbFTHv-eQAsj0z3Dd450P0JOGOQMmDxf5Iu3lBfAVM5YDpzvkAkDVWWyBrVLJlAJlpUFEwfkMKUFAGNlXe2TA16ArOoaJuR51vneW9PRsB5sWGKiwVET4uAtNdHO6fyzib6lEVfGR-p7asZsuuw9xK6lyfcvHWYW-wEjxY8VRo-9xSOy50yX8Hh7p-Tp-upxdpvdP9zczS7vMytkMWRKWIGgyhKkw4aDE9AK5aR1wkopalfxRggwklcFFzXnReMaYerKtg0XSvIpOdvsrmJ4XWMa9NIni11negzrpAteVkIqztSIsg1qY0gpotOr6JcmfmoG-tunXujRp_72qRnTo8-xc7qdXzdLbP8avwJH4GID4Pjkm8eok_0R0PqIdtBt8P_MfwGIU4Wt</recordid><startdate>202009</startdate><enddate>202009</enddate><creator>Soares, Tony R.</creator><creator>Melo, Ryan</creator><creator>Amorim, Pedro</creator><creator>Ministro, Augusto</creator><creator>Sobrinho, Gonçalo</creator><creator>Silvestre, Luís</creator><creator>Fernandes e Fernandes, Ruy</creator><creator>Martins, Carlos</creator><creator>Fernandes e Fernandes, José</creator><creator>Pedro, Luís Mendes</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202009</creationdate><title>Clinical outcomes of aortic arch hybrid repair in a real-world single-center experience</title><author>Soares, Tony R. ; Melo, Ryan ; Amorim, Pedro ; Ministro, Augusto ; Sobrinho, Gonçalo ; Silvestre, Luís ; Fernandes e Fernandes, Ruy ; Martins, Carlos ; Fernandes e Fernandes, José ; Pedro, Luís Mendes</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c462t-94c4e095506feb30f40d49f6cf4c6648f73b440a6372348332bfb4a87cdb34963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Aneurysm, Dissecting - diagnostic imaging</topic><topic>Aneurysm, Dissecting - mortality</topic><topic>Aneurysm, Dissecting - surgery</topic><topic>Aortic Aneurysm, Thoracic - diagnostic imaging</topic><topic>Aortic Aneurysm, Thoracic - mortality</topic><topic>Aortic Aneurysm, Thoracic - surgery</topic><topic>Aortic arch</topic><topic>Aortic Rupture - diagnostic imaging</topic><topic>Aortic Rupture - mortality</topic><topic>Aortic Rupture - surgery</topic><topic>Blood Vessel Prosthesis</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - instrumentation</topic><topic>Blood Vessel Prosthesis Implantation - mortality</topic><topic>Endoleak - etiology</topic><topic>Endoleak - surgery</topic><topic>Endovascular procedures</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - instrumentation</topic><topic>Endovascular Procedures - mortality</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multimorbidity</topic><topic>Portugal</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Spinal cord ischemia</topic><topic>Stroke</topic><topic>Stroke - etiology</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Soares, Tony R.</creatorcontrib><creatorcontrib>Melo, Ryan</creatorcontrib><creatorcontrib>Amorim, Pedro</creatorcontrib><creatorcontrib>Ministro, Augusto</creatorcontrib><creatorcontrib>Sobrinho, Gonçalo</creatorcontrib><creatorcontrib>Silvestre, Luís</creatorcontrib><creatorcontrib>Fernandes e Fernandes, Ruy</creatorcontrib><creatorcontrib>Martins, Carlos</creatorcontrib><creatorcontrib>Fernandes e Fernandes, José</creatorcontrib><creatorcontrib>Pedro, Luís Mendes</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Soares, Tony R.</au><au>Melo, Ryan</au><au>Amorim, Pedro</au><au>Ministro, Augusto</au><au>Sobrinho, Gonçalo</au><au>Silvestre, Luís</au><au>Fernandes e Fernandes, Ruy</au><au>Martins, Carlos</au><au>Fernandes e Fernandes, José</au><au>Pedro, Luís Mendes</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical outcomes of aortic arch hybrid repair in a real-world single-center experience</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2020-09</date><risdate>2020</risdate><volume>72</volume><issue>3</issue><spage>813</spage><epage>821</epage><pages>813-821</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>Aortic arch aneurysmal disease remains a therapeutic challenge. For patients unsuitable for standard open surgery, hybrid repair with debranching of the supra-aortic arteries followed by thoracic endovascular grafting has been shown to be an effective solution. The aim of this study was to report the clinical outcomes of a single-institution experience using hybrid aortic arch repair. The cases of all consecutive patients submitted to hybrid aortic arch repair between January 2010 and June 2018 were prospectively collected and retrospectively analyzed. The outcomes of the study were 30-day mortality, perioperative complications, 2-year survival, endoleak, and reintervention rates. A total of 35 patients with a median age of 71 years (interquartile range, 62-77 years) were submitted to hybrid aortic arch repair, with a median follow-up of 26.9 months (interquartile range, 2.4-63.6 months). Ten procedures (28.6%) were performed urgently for contained rupture. The most common etiology was degenerative (n = 14 [40.0%]). The proximal landing zones according to the Ishimaru classification were zone 2 in 20 patients (57.1%), zone 1 in 12 patients (34.3%), and zone 0 in 3 patients (8.6%). Early endoleaks were observed in six patients (17.1%), equally distributed between type I and type II. Late endoleaks were identified in 4 of 24 patients (16.7%; type I, n = 2 [8.3%]; type II, n = 1 [4.2%]; and type III, n = 1 [4.2%]). Thirty-day mortality rate was 14.3% (n = 5) with an early death rate of 8.7% (2/23) in elective cases and 30.0% (3/10) in urgent cases (odds ratio [OR], 4.93; confidence interval [CI], 0.68-35.67; P = .128). Except in one patient, 30-day mortality was associated with landing zone 0 or zone 1 (26.7% vs 5.0%; OR, 6.91; CI, 0.68-69.86; P = .141). Three patients (8.6%) suffered a postoperative stroke, and no episodes of spinal cord ischemia were observed. Two-year survival rate was 67.8% (CI, 49.4%-80.8%). Survival rates were significantly lower with increasing age (hazard ratio [HR], 1.10; CI, 1.03-1.18; P = .004), urgent procedure (HR, 4.80; CI, 1.56-14.80; P = .003), zone 0 or zone 1 (HR, 6.34; CI, 1.73-23.18; P = .001), presence of arrhythmia (HR, 3.76; CI, 1.22-11.62; P = .013), and cerebrovascular disease (HR, 4.12; CI, 1.38-12.35; P = .006). A multivariate analysis identified age (HR, 1.11; P = .047) and zone 0 or zone 1 (HR, 4.93; P = .033) as the only predictors for overall mortality. Hybrid aortic arch repair seems to be an alternative for higher risk patients not suitable for open repair, but selection of patients is crucial and may benefit from further refinement. In this study, worse outcomes were seen in older patients and those who required more proximal landing zones.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32067880</pmid><doi>10.1016/j.jvs.2019.11.033</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record>
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subjects Age Factors
Aged
Aneurysm, Dissecting - diagnostic imaging
Aneurysm, Dissecting - mortality
Aneurysm, Dissecting - surgery
Aortic Aneurysm, Thoracic - diagnostic imaging
Aortic Aneurysm, Thoracic - mortality
Aortic Aneurysm, Thoracic - surgery
Aortic arch
Aortic Rupture - diagnostic imaging
Aortic Rupture - mortality
Aortic Rupture - surgery
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - instrumentation
Blood Vessel Prosthesis Implantation - mortality
Endoleak - etiology
Endoleak - surgery
Endovascular procedures
Endovascular Procedures - adverse effects
Endovascular Procedures - instrumentation
Endovascular Procedures - mortality
Female
Humans
Male
Middle Aged
Multimorbidity
Portugal
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Spinal cord ischemia
Stroke
Stroke - etiology
Time Factors
Treatment Outcome
title Clinical outcomes of aortic arch hybrid repair in a real-world single-center experience
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