A Systematic Review of Total Endovascular Aortic Arch Repair: A Promising Technology

Total endovascular aortic arch repair (TEAAR) represents an emerging alternative for the treatment of aortic arch disease in patients at prohibitive risk for open surgery. A systematic review of TEAAR was performed to delineate early outcomes with this new technology. All studies (excluding single-patient case reports) of CE-certified “custom made” or “off-the-shelf” zone 0 stent graft deployments were included. The primary search of Medline, Embase, CINAHL, and the Cochrane CENTRAL registry was supplemented with searches of Web of Science, ClinicalTrials.gov, and conference abstracts (within last 3 years), and a hand search of citations within relevant articles. Articles underwent 2-stage screening by 2 independent reviewers before inclusion. Fifteen relevant investigations were identified. Indications for TEAAR were chronic arch dissection with degenerative aneurysmal disease (54%, 148/273), pure arch aneurysm (41%, 112/273), penetrating atherosclerotic ulcer (2%, 5/273), and type IA endoleak from a zone 2 thoracic endograft (1%, 3/273). Double-branch (70%, 192/273), triple-branch (19%, 53/273), and single-branch (into innominate artery; 10%, 28/273) devices were used. Adjunct left carotid–subclavian bypass occurred in 90% of double- and single-branch procedures. Procedural success with TEAAR was 93% (95% CI 85.8%-96.3%). The proportion of all-cause mortality was 16% (95% CI 8%-26%), stroke 14% (8%-24%), peripheral vascular events 7% (1%-33%), and myocardial infarction 4% (2%-7%). Endoleaks were identified in 13% (7%-25%) of the study population. TEAAR represents an emerging option for the management of aortic arch disease wth high procedural success rates and acceptable early outcomes in a high-risk patient population. Le traitement endovasculaire des anévrismes de la crosse aortique (TEACA) représente une alternative émergente pour le traitement de l’anévrisme de la crosse aortique chez les patients présentant un risque prohibitif pour la chirurgie effractive. Une revue systématique au sujet du TEACA a été réalisée afin de caractériser les premiers retours de cette nouvelle technologie. À l'exception des rapports de cas cliniques uniques, toutes les études portant sur le déploiement d'une endoprothèse en zone 0 certifiée CE ont été incluses, que l'endoprothèse soit fabriquée sur mesure ou disponible commercialement. Une recherche initiale dans Medline, Embase, CINAHL et le registre Cochrane CENTRAL a été complétée par des recherches dans Web of Science