Hybrid treatment of aortic arch disease with ascending aorta to carotid artery revascularization and subsequent endovascular repair

Objective To summarize the experience of treating aortic arch disease with ascending aorta to carotid artery revascularization and subsequent endovascular repair. Methods From January 2002 to June 2013,10 high risk patients with aortic arch disease were treated with ascending aorta to carotid artery revascularization with subsequent endovascular repair in the First Affiliated Hospital, Sun Yat-sen University.There were 9 male and 1 female patients with a mean age of (54±14) years (ranging from 34 to 71 years).Of the 10 patients,8 were aortic dissection and 2 were thoracic aortic aneurysm.All aortic arch debranching was performed with mid-sternotomy,including 7 ascending aorta to innominate artery and left common carotid artery bypass,and 3 ascending aorta to left common carotid artery and left subclavian artery bypass.Subsequently,simultaneous (n=5) and staged (n=5,mean interval (7±4) days) endovascular repair were performed via femoral artery. Results Technical success rate was 10/10.The 30 day-mortality was 3/10,including 1 brain stem infarction,1 circulatory failure and 1 aorto-tracheal fistula.Complication included 1 type Ⅱ endoleak.The median time of follow-up was 24 (14) months.CT scanning was performed at 1,3 months and annually thereafter.There was no death and no occlusion of bypass during follow-up.No complication occurred except 1 existing type Ⅱ endoleak. Conclusion Ascending aorta to carotid artery revascularization with subsequent endovascular repair is suitable for high risk aortic arch pathology patients in poor general condition with little tolerance to aortic arch replacement. Key words: Aortic disease; Angioplasty; Stents