Early and Mid-Term Outcomes of Open versus Endovascular Left Subclavian Artery Debranching for Thoracic Aortic Diseases.
Ann Thorac Cardiovasc Surg
; 28(3): 193-203, 2022 Jun 20.
Article
em En
| MEDLINE
| ID: mdl-34937820
ABSTRACT
PURPOSE:
To compare open versus endovascular left subclavian artery debranching for thoracic endovascular aortic repair of thoracic aortic pathologies.METHODS:
This is a retrospective study of patients receiving left subclavian artery debranching in our institution from October 2009 to January 2020. The primary outcome was freedom from aortic reintervention. Secondary outcomes were type I endoleaks, left subclavian artery (LSA) debranching failure, stroke, technical or clinical success, procedure-related reintervention, as well as 30-day or overall all-cause and aorta-related mortality.RESULTS:
Forty-eight patients received parallel graft-based (n = 24, ENDO; median age 75 years [70-80 years]) or open (n = 24, OPEN; median age 71 years [59-75 years]) debranching for type B aortic dissection (n = 25), degenerative aneurysm (n = 12), type IA endoleak (n = 6), suture-associated (n = 3) or ostial LSA aneurysm (n = 1), or penetrating aortic ulcer (n = 1). The median follow-up was 36 months (13-61 months). After 16 months, aortic reintervention-free survival in groups OPEN and ENDO was 91% (95% confidence interval [CI] 79 to 100%) and 86% (73 to 100%) (p = 0.71), respectively. After 36 months, all-cause survival in groups OPEN and ENDO was 74% (95% CI 55 to 99%) and 79% (95% CI 64 to 97%) (p = 0.74), respectively; freedom from aorta-related mortality was 81% (95% CI 62 to 100%) and 91% (95% CI 80 to 100%) (p = 0.78), respectively. Group OPEN presented less type I endoleaks (OPEN/ENDO = 3/19, p <0.001) and higher technical (OPEN/ENDO = 81/36%, p = 0.003) and clinical success rates (OPEN/ENDO = 67/36%, p = 0.047). No statistical differences were found for other outcomes.CONCLUSION:
Both strategies achieved comparable reintervention and mortality rates, but open debranching should be preferred due to its higher technical and clinical success and less type I endoleaks.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Doenças da Aorta
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Aneurisma da Aorta Torácica
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Implante de Prótese Vascular
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Procedimentos Endovasculares
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Dissecção Aórtica
Tipo de estudo:
Etiology_studies
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Observational_studies
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Risk_factors_studies
Limite:
Aged
/
Humans
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article