Efficacy and safety of debranching technique with zone 1 thoracic endovascular aortic repair in high-risk patients with distal aortic arch lesions.

Background: To share the results of the debranching technique with zone 1 thoracic endovascular aortic repair (TEVAR) in high-risk patients chosen based on older age, cardiopulmonary comorbidities, and unfit for open surgical procedures, who have distal arch lesions.

Methods: Between January 2020 and August 2022, 15 patients treated in our practice were treated with the debranching technique TEVAR (d-TEVAR) for distal aortic arch lesions requiring a stent-graft landing in zone 1. We retrospectively reviewed clinical data and significant outcomes for prognostic analyses. Lesion types included chronic Stanford type B aortic dissections (n = 10), distal arch aneurysms (n = 4), and one pseudoaneurysm. All lesions were chronic, with no involvement of visceral vessels. These patients were considered high-risk in a multidisciplinary fashion.

Results: All procedures were completed with a technical success rate of 100%. The mean operative time was 317 ± 48 min. No in-hospital mortality or major complications were recorded. One patient had a type I endoleak at 3 months that was treated conservatively due to no symptoms during follow-up (median 16 months, (range 12-20)), and in one patient, this was associated with fatal cerebral infarction at 4 months following the procedure, yielding a stroke rate of 6.7%. Graft survival for all patients, via a Kaplan-Meier analysis, was 89.3%.

Conclusions: For distal aortic arch lesions requiring a zone 1 stent-graft landing, d-TEVAR is an effective and safe alternative treatment option with promising short-term results in well-selected high-risk patients and can be applied when open surgery constitutes a significant surgical risk.