Thoracic endovascular aortic repair with aortic arch vessel revascularization

Background Revascularization of aortic arch vessels was performed with thoracic endovascular aortic repair (TEVAR) to preserve the endoprosthesis landing zone in 19 high-risk patients. Methods The operative procedure used was a bypass or transposition involving the common carotid and subclavian arteries. Homemade fenestrated stent-grafts, deployed in landing zone 0, were used for TEVAR. Results All lesions resolved without endoleaks. No perioperative deaths occurred; seven patients had postoperative complications. One patient with acute respiratory distress syndrome required reoperation to change the bypass route and permit tracheostomy. One patient died of pneumonia 2 months after treatment, after an anastomotic pseudoaneurysm and cerebral infarction developed and an operation was performed to obtain hemostasis. The procedure-related mortality was 5.3%. Conclusion Aortic arch vessel revascularization before TEVAR may permit less invasive surgery, although careful patient selection is essential.