Résumé
The aim of this study was to evaluate the short- and midterm results following endovascular repair of dissecting aortic arch aneurysm after surgical treatment of acute type A dissection.BACKGROUNDThe aim of this study was to evaluate the short- and midterm results following endovascular repair of dissecting aortic arch aneurysm after surgical treatment of acute type A dissection.Between 2003 and 2010, six consecutive patients previously operated for acute type A dissection underwent endovascular repair of dissecting aortic arch aneurysm (six men, mean age: 63 ± 9.8 years); one of the aneurysms was ruptured. Follow-up computed tomography scans were performed at 1 week, at 3 and 6 months, and annually thereafter.METHODSBetween 2003 and 2010, six consecutive patients previously operated for acute type A dissection underwent endovascular repair of dissecting aortic arch aneurysm (six men, mean age: 63 ± 9.8 years); one of the aneurysms was ruptured. Follow-up computed tomography scans were performed at 1 week, at 3 and 6 months, and annually thereafter.All endografts were successfully deployed (TAG [2], Valiant [4]). All the patients underwent hybrid technique with supra-aortic debranching (through a sternotomy approach in four cases and through a cervical approach in two cases) and simultaneous or staged endovascular stent-grafting. During the same operative time, one patient underwent, on full cardiopulmonary bypass, saphenous vein bypass from the ascending aorta to the anterior descending coronary artery. One permanent neurologic event was observed. After a mean follow-up of 22.3 ± 14.6 months, no aortic-related mortality was observed. No cases of stent-graft migration or secondary rupture were observed. The ruptured aortic arch aneurysm presented a type I endoleak at 6 months and was successfully treated with a second endograft. One patient died of an unrelated cause 7 months after surgical repair.RESULTSAll endografts were successfully deployed (TAG [2], Valiant [4]). All the patients underwent hybrid technique with supra-aortic debranching (through a sternotomy approach in four cases and through a cervical approach in two cases) and simultaneous or staged endovascular stent-grafting. During the same operative time, one patient underwent, on full cardiopulmonary bypass, saphenous vein bypass from the ascending aorta to the anterior descending coronary artery. One permanent neurologic event was observed. After a mean follow-up of 22.3 ± 14.6 months, no aortic-related mortality was observed. No cases of stent-graft migration or secondary rupture were observed. The ruptured aortic arch aneurysm presented a type I endoleak at 6 months and was successfully treated with a second endograft. One patient died of an unrelated cause 7 months after surgical repair.Our experience demonstrates promising potential of endovascular repair of dissecting aortic arch aneurysm after surgical treatment of acute type A dissection. The potential to diminish the magnitude of the surgical procedure and the consequences of aortic arch exposure, and above all avoiding the need for circulatory arrest, is promising and mandates further investigation to determine the efficacy and durability of this technique.CONCLUSIONSOur experience demonstrates promising potential of endovascular repair of dissecting aortic arch aneurysm after surgical treatment of acute type A dissection. The potential to diminish the magnitude of the surgical procedure and the consequences of aortic arch exposure, and above all avoiding the need for circulatory arrest, is promising and mandates further investigation to determine the efficacy and durability of this technique.