Mid-term results of supraaortic transpositions for extended endovascular repair of aortic arch pathologies

Objective: To evaluate mid-term results of supraaortic transpositions for extended endovascular repair of aortic arch pathologies. Methods: From October 2002 to July 2006, 27 patients (mean age 72 years) with aortic arch diseases were treated (arch aneurysms n = 18, type B dissections n = 5, perforating ulcers n = 4). Strategy for distal arch disease was autologous sequential transposition of the left carotid artery and of the left subclavian artery in 17 patients. Strategy for entire arch disease was total supraaortic rerouting using a reversed bifurcated prosthesis in 10 patients. Endovascular stent-graft placement was performed metachronously thereafter. Results: Two in-hospital deaths occurred (myocardial infarction on the day prior to discharge n = 1, rupture while waiting for stent-graft placement n = 1). At completion angiography, all reconstructions were fully patent. Four patients had small type Ia endoleaks, two of them resolving spontaneously. Mean follow-up is 15 months (1–43 months). Three late deaths occurred (myocardial infarction n = 2, sudden unknown death n = 1). One-year survival was 83% and 3-year survival was 72%, respectively. Redo stent-graft placement was performed in one patient after 25 months (type III endoleak). The remaining patients had normal CT scans with regular perfusion of the supraaortic branches without any signs of endoleaks. Conclusions: Mid-term results of alternative treatment approaches in elderly patients with aortic arch pathologies are satisfying. Extended applications provide safe and effective treatment in patients at high risk for conventional repair.