EARLY AND MID-TERM RESULTS OF ENDOVASCULAR TREATMENT OF THORACIC AORTA DISEASES: A SINGLE CENTRE EXPERIENCE

Abstract An analysis was conducted to assess early and mid-term outcomes of patients following thoracic endovascular aortic repair (TEVAR) for type B thoracic aorta dissection, descending thoracic aneurysm, or traumatic aortic transection. From January 2016 thru December 2018, twenty-seven patients (23 male, 4 female), mean age of 57 years, affected by type B dissection (n=13, 48.2%), thoracic aneurysm (n=9, 33.3%) and post-traumatic aortic isthmus rupture (n=5, 18.5%) were treated by TEVAR with and without left subclavian artery revascularization. All procedures were performed in a hybrid operating room by means of general (n=12) or regional (n=15) anesthesia. A combined brachial artery and bilateral femoral artery access was used in all patients. To achieve adequate proximal thoracic aorta landing zone length, coverage of the left subclavian artery with proximal endovascular plug occlusion was performed in 17 (62.9%) patients; including 4 patients having a carotid-subclavian artery bypass before TEVAR stent-graft deployment. Primary procedural success rate was 96.3%; one patient had a type Ib endoleak which was treated by distal stent graft extension. Four adverse outcomes occurred in the immediate post-operative period, including 2 cases of left upper arm acute ischemia (7.4%), an ischemic stroke (3.7%), and asymptomatic iliac artery dissection (3.7%). During a mean follow-up of 18 months, no grafts-related deaths or endoleak occurred. One patient developed symptomatic subclavian steal syndrome one month after operation and underwent to a left carotid-subclavian artery bypass with symptom resolution. One patient died occurred 6 months after TEVAR due to neoplasm. Our experience indicates TEVAR is a safe and less invasive alternative to open surgery for a spectrum of thoracic aorta diseases, especially for urgent conditions and in patients with high-risk surgical co-morbidities.