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Squiers JJ, DiMaio JM, Schaffer JM, et al. Surgical Debranching versus Branched Endografting in Zone 2 Thoracic Endovascular Aortic Repair. J Vasc Surg. 2022;doi: 10.1016/j.jvs.2021.12.068.
Squiers, J. J., DiMaio, J. M., Schaffer, J. M., Baxter, R. D., Gable, C. E., Shinn, K. V., Harrington, K., Moore, D. O., Shutze, W. P., Brinkman, W. T., & Gable, D. R. (2022). Surgical Debranching versus Branched Endografting in Zone 2 Thoracic Endovascular Aortic Repair. Journal of vascular surgery, . https://doi.org/10.1016/j.jvs.2021.12.068
Squiers, John J, et al. "Surgical Debranching versus Branched Endografting in Zone 2 Thoracic Endovascular Aortic Repair." Journal of vascular surgery vol. (2022). doi: https://doi.org/10.1016/j.jvs.2021.12.068
Squiers JJ, DiMaio JM, Schaffer JM, Baxter RD, Gable CE, Shinn KV, Harrington K, Moore DO, Shutze WP, Brinkman WT, Gable DR. Surgical Debranching versus Branched Endografting in Zone 2 Thoracic Endovascular Aortic Repair. J Vasc Surg. 2022 Jan 05; doi: 10.1016/j.jvs.2021.12.068. Epub 2022 Jan 05. PMID: 34998942.
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J Vasc Surg. 2022 Jan 05; doi: 10.1016/j.jvs.2021.12.068. Epub 2022 Jan 05.

Surgical Debranching versus Branched Endografting in Zone 2 Thoracic Endovascular Aortic Repair.

Journal of vascular surgery

John J Squiers, J Michael DiMaio, Justin M Schaffer, Ronald D Baxter, Cara E Gable, Kathryn V Shinn, Katherine Harrington, David O Moore, William P Shutze, William T Brinkman, Dennis R Gable

Affiliations

  1. Baylor Scott & White Research Institute, Baylor Scott & White Heart Hospital Plano; Plano, TX. Electronic address: [email protected].
  2. Department of Cardiothoracic Surgery, Baylor Scott & White Heart Hospital Plano; Plano, TX.
  3. Department of Surgery, Baylor University Medical Center; Dallas, TX.
  4. Department of Biomedical Sciences, Texas A&M University; College Station, TX.
  5. Baylor Scott & White Research Institute, Baylor Scott & White Heart Hospital Plano; Plano, TX.
  6. Department of Vascular Surgery, Baylor Scott & White Heart Hospital Plano; Plano, TX.

PMID: 34998942 DOI: 10.1016/j.jvs.2021.12.068

Abstract

INTRODUCTION: Left subclavian artery (LSA) revascularization is recommended in patients undergoing elective thoracic endovascular aortic repair (TEVAR) with proximal zone 2 landing requiring coverage of the LSA. The gold-standard remains surgical LSA revascularization, but recently the feasibility of branched endografts has been demonstrated. We compared the perioperative and mid-term outcomes of these approaches.

METHODS: A retrospective review of consecutive patients undergoing TEVAR with proximal zone 2 landing at a single center from 2014-2020 was performed. Patients were divided into cohorts for comparison: those undergoing surgical revascularization (SR-TEVAR group) and those undergoing thoracic branched endografting with an investigational device (TBE group). Patients who did not receive LSA revascularization were excluded. Perioperative outcomes including procedural success, death, stroke, limb ischemia, and length of stay were compared. Kaplan-Meier survival curves were compared with the log-rank test. The cumulative incidences of device-related endoleak (type I and III) and device-related reintervention, accounting for death as a competing hazard, were compared with the Fine-Gray test.

RESULTS: A total of 55 patients were included: 31 (56%) SR-TEVAR and 24 (44%) TBE. Preoperative demographics and comorbidities were similar between the groups. Procedural success was 100% in both cohorts, and there were no periprocedural strokes or left upper extremity ischemic events. One operative/30-day mortality (TBE 4.2% vs SR-TEVAR 3.2%, p=0.99) occurred in each cohort. Total operative time (minutes, TBE 203 ± 79 vs SR-TEVAR 250 ± 79 p=0.03) and total length of stay (days, TBE 5.2 ± 3.6 vs SR-TEVAR 9.9 ± 7.2, p=0.004) were both significantly shorter in the TBE group. There was no difference in mid-term survival (log-rank p=0.50), nor the cumulative incidence of device-related endoleak (Fine-Gray p=0.51) or reintervention (Fine-Gray p=0.72). There have been no occlusions of the TBE graft nor surgical bypass/transpositions after a mean follow-up for 28 ± 16 and 34 ± 24 months, respectively.

CONCLUSIONS: Thoracic branched endografting can be performed with similar procedural success and comparable safety profile to TEVAR with surgical revascularization, while reducing total length of stay, in patients requiring proximal zone 2 coverage. Mid-term outcomes of each approach are also similar. Prospective, randomized comparisons of these techniques are warranted.

Copyright © 2022. Published by Elsevier Inc.

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