Endovascular arch repair of anastomotic aneurysm and pseudoaneurysm in patients after open repair of the ascending aorta and aortic arch: A case series.

Becker, Daniel; Stana, Jan; Prendes, Carlota F; Konstantinou, Nikolaos; Öz, Tugce; Pichlmaier, Maximilian; Peterss, Sven; Tsilimparis, Nikolaos (2023). Endovascular arch repair of anastomotic aneurysm and pseudoaneurysm in patients after open repair of the ascending aorta and aortic arch: A case series. European journal of cardio-thoracic surgery, 64(4) Oxford University Press 10.1093/ejcts/ezad345

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OBJECTIVES

Aim of study was to investigate the outcomes of endovascular arch repair (b-TEVAR) with a custom-made double or triple branched arch endograft in patients with distal anastomotic aneurysms after open repair of the ascending aorta or proximal arch replacement.

METHODS

Retrospective analysis was conducted of all consecutive patients with anastomotic aneurysms after open surgical repair involving the ascending aorta and/or aortic arch treated with b-TEVAR. All patients were treated with a custom-made double or triple inner-branched arch endograft. Study end-points were technical success, 30-day and follow-up mortality/morbidity and re-interventions.

RESULTS

Between 2018 and 2022, ten patients were treated with custom-made double or triple branched TEVAR due to anastomotic aneurysms after open ascending aorta and/or proximal aortic arch replacement. Eight patients received a triple and two a double arch branched endograft. Eight cases were performed electively and two urgently for contained rupture. Technical success was achieved in nine cases (90%). All elective patients survived. Two patients treated due to contained ruptures expired. Within 30 postoperative days, one transient ischaemic attack occurred. No early endograft-related re-interventions were necessary. Median follow-up was 20 months. One patient died two months after discharge due to sepsis caused by pneumonia. No further deaths or endograft-related re-interventions were observed.

CONCLUSIONS

Endovascular aortic arch repair with double or triple inner-branched arch endograft for anastomotic aneurysms after open ascending and/or proximal arch replacement is technically feasible and a promising alternative in a patient cohort unfit for surgery.

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