Endovascular Debranching Technique (Zone 1) in Hybrid Surgical Treatment of Thoracic Aorta

Renat Akchurin, Timur Imaev, Petr Lepilin, Aleksandr Kolegaev, Ivan Kuchin, Dmitriy Salichkin, Aleksey Komlev

National medical research center for cardiology, Moscow, Russia

Date, time and location: 2018.05.26 13:30, Congress Hall, 2F–A

Abstract

Aim: To analyze the outcomes of supraaortic debranching technique, which is performed to create an endoprosthesis landing zone as a part of aortic arch and descending aorta hybrid surgical treatment. 

Materials and methods: Since 2010 to 2017 more than 40 patients underwent hybrid surgical treatment of aortic arch pathology. 30 patients had a proximal neck in zone1 according to Ishimaru classification. For this reason, debranching of the left common carotid and left subclavian arteries was performed. All the patients were divided into two groups regarding to anatomical issues. 8 patients (group 1) underwent conventional left common carotid and left subclavian arteries bypass. Other 18 patients (group 2) underwent left carotid artery endodebranchig using “chimney”-technique combined with left carotid-subclavian bypass formed the second group. Debranching efficacy criteria were as follows: 1) supraaortic vessels patency and 2) absence of endoleak type 1a assessed by intraoperative angiography and multidetector computed tomography.

Results: Stent graft implantation into zone 1 after debranching was performed within the same procedure in all cases. Intraoperative angiography confirmed supraaortic vessels patency in all cases. In 1 case there was insignificant 1a type endoleak that was left untreated. Multidetector computed tomography (7 days, 3 and 6 months and 1 year after procedure) determined no endoleaks or supraaortic vessels occlusions in both groups. In one case late period occlusion of carotid-subcluvian shunt without ischemia signs was detected.

Conclusion: Endodebranching of the aortic arch with use of “chimney” technique to produce an adequate landing in zone 1 is assumed to be a good and safe alternative to conventional methods.