TY - JOUR
T1 - Long-term results of hybrid repair techniques for Kommerell's diverticulum
AU - Tinelli, Giovanni
AU - Ferrer, Ciro
AU - Giudice, Rocco
AU - Ferraresi, Marco
AU - Pogany, Gabriele
AU - Cao, Piergiorgio
AU - Tshomba, Yamume
AU - Montenegro, C.
AU - De Nigris, F.
AU - Minelli, Fabrizio
AU - Sica, S.
AU - Coscarella, C.
PY - 2020
Y1 - 2020
N2 - Objective: The aim of this study was to evaluate early and late results of hybrid repair techniques for Kommerell's diverticulum (KD). Methods: All patients who underwent hybrid repair (thoracic endovascular aortic repair + supra-aortic debranching) for KD between 2009 and 2018 were included in this retrospective multicenter study (three Italian centers). A proximal landing zone (PLZ) of at least 2 cm of healthy aorta was considered adequate for the deployment of a standard thoracic stent graft. The early end points were technical success, in-hospital mortality, and cerebrovascular events. Late outcomes included survival, reintervention, and patency of supra-aortic debranching. We used an embryogenetic anomaly based aortic arch classification for PLZ evaluation to identify the most appropriate hybrid adjunct. Results: Sixteen patients with KD were included. According to the aforementioned classification, stent graft deployment was required in six patients (37.5%) in PLZ 0, nine patients (56.3%) in PLZ 1, and one patient (6.3%) in PLZ 2. Technical success was achieved in all patients. One patient (6.3%) died in the hospital because of posterior cerebral hemorrhage after total debranching (PLZ 0). No further cerebrovascular events were observed. One patient (6.3%) had an asymptomatic left subclavian artery-right left subclavian artery bypass occlusion and required early reintervention. The 30-day secondary patency of supra-aortic debranching was 100%. Two type II endoleaks (12.5%) were detected at 1 month through computed tomography angiography. Further transient complications were found in three cases: hemidiaphragm paralysis in one patient and recurrent laryngeal nerve paralysis in two patients. At a mean follow-up of 48 months, four patients had died because of nonaortic reasons, and one RCCA-right subclavian artery bypass had lost its patency. None of the patients reported any growth of KD after hybrid repair. Ten patients (62.5%) showed aneurysmal sac shrinkage of at least 5 mm. Conclusions: Hybrid repair is confirmed to be a safe and effective approach for KD. Operative risk is associated primarily with the invasiveness of the hybrid adjunct.
AB - Objective: The aim of this study was to evaluate early and late results of hybrid repair techniques for Kommerell's diverticulum (KD). Methods: All patients who underwent hybrid repair (thoracic endovascular aortic repair + supra-aortic debranching) for KD between 2009 and 2018 were included in this retrospective multicenter study (three Italian centers). A proximal landing zone (PLZ) of at least 2 cm of healthy aorta was considered adequate for the deployment of a standard thoracic stent graft. The early end points were technical success, in-hospital mortality, and cerebrovascular events. Late outcomes included survival, reintervention, and patency of supra-aortic debranching. We used an embryogenetic anomaly based aortic arch classification for PLZ evaluation to identify the most appropriate hybrid adjunct. Results: Sixteen patients with KD were included. According to the aforementioned classification, stent graft deployment was required in six patients (37.5%) in PLZ 0, nine patients (56.3%) in PLZ 1, and one patient (6.3%) in PLZ 2. Technical success was achieved in all patients. One patient (6.3%) died in the hospital because of posterior cerebral hemorrhage after total debranching (PLZ 0). No further cerebrovascular events were observed. One patient (6.3%) had an asymptomatic left subclavian artery-right left subclavian artery bypass occlusion and required early reintervention. The 30-day secondary patency of supra-aortic debranching was 100%. Two type II endoleaks (12.5%) were detected at 1 month through computed tomography angiography. Further transient complications were found in three cases: hemidiaphragm paralysis in one patient and recurrent laryngeal nerve paralysis in two patients. At a mean follow-up of 48 months, four patients had died because of nonaortic reasons, and one RCCA-right subclavian artery bypass had lost its patency. None of the patients reported any growth of KD after hybrid repair. Ten patients (62.5%) showed aneurysmal sac shrinkage of at least 5 mm. Conclusions: Hybrid repair is confirmed to be a safe and effective approach for KD. Operative risk is associated primarily with the invasiveness of the hybrid adjunct.
KW - Hybrid repair
KW - Kommerell's diverticulum
KW - Personalized medicine
KW - Thoracic endovascular aortic repair
KW - Hybrid repair
KW - Kommerell's diverticulum
KW - Personalized medicine
KW - Thoracic endovascular aortic repair
UR - http://hdl.handle.net/10807/149951
UR - https://www.sciencedirect.com/science/article/pii/s0741521419329015?via=ihub
U2 - 10.1016/j.jvs.2019.11.052
DO - 10.1016/j.jvs.2019.11.052
M3 - Article
SN - 0741-5214
VL - 72
SP - 1213
EP - 1221
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
ER -