Cervical Debranching in the Endovascular Era: A Single Centre Experience

Konstantinou, Nikolaos; Debus, Eike S.; Vermeulen, Christine F. W.; Wipper, Sabine; Diener, Holger; Larena-Avellaneda, Axel; Koelbe, Tilo und Tsilimparis, Nikolaos (2019): Cervical Debranching in the Endovascular Era: A Single Centre Experience. In: European Journal of Vascular and Endovascular Surgery, Bd. 58, Nr. 1: S. 34-40

Abstract

Objective/Background: Debranching of the supra-aortic arteries is a common practice either as part of a hybrid treatment of aortic arch pathology or owing to arterial occlusive disease. Results of the debranching techniques have not been reported frequently. Methods: This was a retrospective single centre study of all consecutive patients with cervical debranching procedures as part of hybrid aortic arch repair. Results: Between 2010 and 2017, 201 patients underwent 211 cervical debranching procedures in a tertiary centre. Mean +/- SD patient age was 67.7 +/- 10.7 years (70.6% males;n = 142/201) and mean +/- SD body mass index (BMI) was 26.3 +/- 5. In 78.7% of the cases carotid-subclavian bypass was performed alone (n = 166/211) followed by transposition of the subclavian artery to the ipsilateral carotid (n = 17/211;8.1%) and in 28 cases (13.3%) a combination of procedures was performed. Twenty-four cases (11.4%) were complicated with local bleeding and 21 cases required re-intervention (10.4%). Nineteen patients (9.5%) developed local peripheral neurological damage post-operatively. Eight patients (3.8%) developed a chylous fistula and five (2.4%) presented with a local wound infection. One patient (0.5%) developed a bypass graft infection. The thirty day mortality was 7.6% (n = 16/211): one death occurred after isolated debranching without thoracic endovascular aneurysm repair (TEVAR;0.5%). Whether the hybrid procedures were undertaken in a single stage (simultaneous TEVAR and cervical debranching) or two stage fashion appeared to have a significant impact on 30 day mortality (single stage n = 9/60 [15%] vs. debranching alone or two stage hybrid procedures n = 7/144 [4.9%];p = .018). The major stroke incidence was 4.3% (n = 9/211);no strokes occurred after isolated debranching. Stroke was correlated with longer operating times (odds ratio [OR] 1.006;95% confidence interval [CI] 1.000-1.011;p = .045) and higher BMI (OR 1.195;95% CI 1.009-1.415;p = .039). Mean +/- SD follow up was 15 +/- 17 months (range 0-89 months). Primary cumulative graft patency during follow up was 98.1% (n = 207/211) and secondary patency was 100%. Conclusion: The results of cervical debranching procedures showed not only excellent patency rates, but also a significant rate of local complications. Carotid-subclavian bypass appeared to be safer with significantly fewer post-operative complications. Staged hybrid procedures also seemed to be safer.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1078-5884
• Sprache: Englisch