Il trattamento endovascolare "off-pump" degli aneurismi dell'arco aortico

Translated title of the contribution: "Off-pump" endovascular treatment of aortic arch aneurysms

Germano Melissano, Efrem Civilini, Francesco Maisano, Alessandro Castiglioni, Luca Asso Bertoglio, Francesco Setacci, Andrea Carozzo, Silvio Magrin, Alberto Zangrillo, Giovanni La Canna, Ottavio Alfieri, Roberto Chiesa

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Traditional repair of aortic arch aneurysms requires cardiopulmonary bypass, hypothermia and circulatory arrest. Endovascular repair is an attractive, less invasive alternative that may change our therapeutic approach. The aim of this study was to review our clinical experience with endovascular treatment of aortic arch aneurysms and to address the new problems in this area. Methods. In the last 5 years, we treated 21 patients for aortic arch pathology with an "off-pump" endovascular repair (18 men, 3 women, mean age 71.4 ± 7.2 years). We used 26 stent grafts (5 Gore Excluder TAG, 3 Endomed Endofit, 6 Medtronic Talent, 12 Cook Zenith TX1) with a mean of 1.2 graft/patient. Proximal fixation of endograft was achieved by means of aortic "de-branching" in 11 cases. In 10 cases the left subclavian artery was intentionally covered without revascularization. Follow-up included clinical examination, chest X-ray and computed tomography at discharge and at 6-month intervals thereafter. Results. Technical success was 85% (18/21). There was one in-hospital death (4.7%) due to endograft migration. We observed 2 cases of type I endoleak (9.5%). One surgical conversion was performed 2 weeks after the procedure, because of total collapse of the stent graft with rupture of three stents. No complications related to the coverage of the left subclavian artery were observed. At a mean follow-up of 18.7 ± 12.8 months, no mortality or morbidity including new-onset endoleak, stent-graft migration and thrombosis of supra-aortic grafts were recorded. Conclusions. Endovascular treatment of aortic arch pathology is feasible even in elderly patients. However, accurate placement in the arch and aneurysm sealing with the currently available devices, may be challenging due to the involvement of supra-aortic vessels, the anatomical curvature of the arch, the high blood flow, and substantial movement of the aorta with each heartbeat.

Translated title of the contribution"Off-pump" endovascular treatment of aortic arch aneurysms
Original languageItalian
Pages (from-to)727-734
Number of pages8
JournalItalian Heart Journal Supplement
Volume5
Issue number9
Publication statusPublished - 2004

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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