Outcomes of hybrid procedure for type B aortic dissection with an aberrant right subclavian artery

We aimed to investigate whether sex differences influence the clinical outcomes of patients who undergo thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). We retrospectively analyzed a prospectively maintained single-center cohort of patients with TBAD who underwent TEVAR between January 2010 and June 2017. We evaluated the in-hospital and long-term mortality and composite end point. Of the 913 patients, 793 (86.8%) were male and 120 (13.1%) were female. Compared to male patients, the female patients were older, more likely to have diabetes mellitus, but less likely to smoke or have hypertension. The proximal landing zone in 0 and 1 was higher in male patients ( P = .023), who were more likely to require an aortic arch bypass. Endoleak, delirium, and ICU stay after stent-graft implantation were also more frequent in men. Sex factor was not associated with in-hospital or long-term mortality or the composite end point in the multivariable regression analyses and Cox regression model. The mean estimated survival time was similar between males and females (2462.9 ± 141.2 vs 2804.1 ± 117.4 days, P = .167) in the propensity score–matched cohort. Despite distinct characteristics between sex, there was no sex-related difference in long-term clinical outcomes after TEVAR for TBAD.

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“…18 An extra-anatomic bypass hybrid procedure or chimney stent was performed in cases with an insufficient aortic arch landing zone. 19,20…”

Section: Description Of Proceduresmentioning

confidence: 99%

Influence of Sex on Outcomes After Thoracic Endovascular Repair for Type B Aortic Dissection

et al. 2021

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“…Several surgical procedures have been reported to treat patients with acute type B aortic syndrome and ARSA, including replacement of the descending aorta, total arch replacement plus stent elephant trunk, only the stented elephant trunk method, hybrid technique, and TEVAR. 7,12 The descending aorta replacement for treating TBAD and ARSA was first reported by DeBakey in 1955. 13 It was not until 1973 that Syme et al carried out the second descending aorta replacement for managing this pathology.…”

Section: Discussionmentioning

confidence: 99%

“…Owing to the rarity of coexistence of ARSA and acute type B aortic syndrome, only a few cases have been reported on the treatment methods, mainly including open surgery, 5,6 and hybrid operation. [7][8][9] Over the past 20 years, thoracic endovascular aortic repair (TEVAR) has been developed rapidly and becomes more accepted in the treatment of acute type B aortic syndrome for its lower mortality and morbidity. However, the existence of ARSA brings additional challenges for TEVAR in repairing the diseased aorta due to preserving the blood supply from the ARSA to brain and right upper extremity.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Aortic Repair With Castor Single-Branched Stent-Graft in Treatment of Acute Type B Aortic Syndrome and Aberrant Right Subclavian Artery

Pang

Qiu

Wang

et al. 2021

Vasc Endovascular Surg

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Objective: In this retrospective study, we presented the results of Castor single-branched stent-graft in a small series of patients with acute type B aortic syndrome and aberrant right subclavian artery (ARSA). Methods: Between January 2019 and November 2019, 5 patients were diagnosed with acute type B aortic syndrome and ARSA (4 patients with intramural hematoma and ARSA, 1 patient with type B aortic dissection and ARSA). All the patients underwent thoracic endovascular aortic repair (TEVAR) using Castor single-branched stent-graft. In-hospital and 3-month outcomes were collected. Results: The mean operative time was 116 ± 20.43 minutes (range 90-145). All the TEVAR procedures were successfully performed without conversion to open surgery (100% success rate). All the ARSAs of the 5 patients were revascularized in situ by Castor single-branched stent-grafts. No deaths and complications were observed in the 3-month follow-up. The maximal diameters of diseased aortas in the 4 patients with IMH decreased 3 months after TEVAR. The false lumen in the graft-covered segment was completely thrombosed in the patient with type B aortic dissection. Conclusions: Castor single-branched stent-graft may be a good choice in treatment of acute type B aortic syndrome and aberrant right subclavian artery.

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“…Successful repair of Kommerell diverticulum using alternative endovascular and hybrid techniques has been reported [13,19,20], with 1 early death (2.6%) reported in a review of 38 cases of hybrid repair procedures [6]. Van Bogerijen and colleagues [21] reported that the evolution of endovascular repair did not affect late outcomes in their 3.0 AE 3.4 years of follow-up.…”

Section: Commentmentioning

confidence: 99%

Graft Replacement of Kommerell Diverticulum and In Situ Aberrant Subclavian Artery Reconstruction

Ikeno

Koda

Yokawa

et al. 2019

The Annals of Thoracic Surgery

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Outcomes of hybrid procedure for type B aortic dissection with an aberrant right subclavian artery

Abstract: Our limited experience demonstrates that a hybrid procedure is a viable and relatively safe treatment strategy for patients with TBAD and an ARSA. A larger series of cases with a longer follow-up is needed to substantiate these results.

Cited by 28 publications

References 21 publications

Influence of Sex on Outcomes After Thoracic Endovascular Repair for Type B Aortic Dissection

Influence of Sex on Outcomes After Thoracic Endovascular Repair for Type B Aortic Dissection

Endovascular Aortic Repair With Castor Single-Branched Stent-Graft in Treatment of Acute Type B Aortic Syndrome and Aberrant Right Subclavian Artery

Graft Replacement of Kommerell Diverticulum and In Situ Aberrant Subclavian Artery Reconstruction

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