5.3 TEVAR with extrathoracic surgical transposition of the
supra-aortic
branches
A 2017 study by Rylski et al. reported surgical outcomes on 43 non-A
non-B aortic dissection patients repaired using TEVAR with extrathoracic
surgical transposition of the supra-aortic branches (Rylski et
al. , 2017). In this study endovascular treatment involved TEVAR with or
without carotid-subclavian bypass or transposition of both left carotid
and left subclavian artery as well as isolated stenting of dissected
visceral vessels (Rylski et al. , 2017). The authors classified
Non-A non-B dissections as descending entry type with entry distal to
the left subclavian artery and dissection extending into the aortic
arch, and arch entry type with entry between the innominate and left
subclavian arteries. These two groups were then compared in terms of
presentation, treatment and outcomes with 21 patients forming this
descending entry group and 22 the arch entry cohort (Rylski et
al. , 2017). The cardiovascular risk profiles of these groups did not
differ and the overwhelmingly majority of aortic segments were not
dilated in patients from both groups. Across both groups the 30 day
mortality rate was 9%, one patient suffered a stroke and two patients
suffered a retrograde type A dissection (Rylski et al. , 2017).
Aortic repair due to new organ malperfusion, rapid aortic growth or
persisting pain was performed in 43% of descending entry patients and
36% arch entry patients with a 0% in hospital mortality.
An earlier study by Lu et al. retrospectively analysed 22 consecutive
patients treated with extrathoracic surgical transposition of the supra
aortic branches for Non-A non-B dissection (Lu et al. , 2011).
Hybrid, scalloped or fenestrated endovascular stent grafts were selected
based on dissection characteristics and median follow up time was 27.1
months with patients assessed with computed tomography angiography.
Primary end points of the study included pathology, complications and
survival rates (Lu et al. , 2011). The authors reported surgery
was successful in all patients except one with an operative complication
and they report a 30-day mortality rate of 9% (Lu et al. , 2011).
Thrombosis had formed in the aortic false lumen of the graft exclusion
segment in all patients however the maximum diameter of this segment was
shown to be decreased in 18 patients and stable in two (Lu et
al. , 2011). Patency was observed at both mid- and long-term follow-up
and no proximal endoleak, graft displacement or deaths were reported in
this period.