Objectives To review current choices and late results of aberrant right subclavian artery aneurysms (ARSAA) repair. Methods All consecutive ARSAA repairs from 2006 to 2013 in seven centers were reviewed. End points were 30-day and late mortality, reintervention rates, and ARSAA-related deaths. Results Included were 21 ARSAA repairs (57% males; mean age, 67 years). Three ruptures (14%) required emergency treatment, and 12 (57%) were symptomatic for dysphagia (33%), dysphonia (24%), and pain (19%). Eight cases presented thoracic aortic aneurysm, two with intramural hematomas, and one with acute type B aortic dissection. Mean ARSAA diameter was 42 mm; a single bicarotid common trunk was present in 38% of cases. Most patients received hybrid procedures (71%), consisting of single (two cases), bilateral (12 cases) subclavian-to-carotid transposition or bypass, or ascending aorta to subclavian by pass (one case) plus thoracic endografting (thoracic endovascular aortic repair [TEVAR]); 19% of cases underwent open repair and 9% simple TEVAR with ARSA overstenting. Perioperative death occurred in two patients (9%): in one case after TEVAR in ruptured ARSAA, requiring secondary sternotomy and aortic bending, and due to multiorgan failure after a hybrid procedure in an elective case. Mean follow-up was 31 ± 20 months. Estimates of Kaplan-Meier 36-month survival was 90%. Late ARSAA-related death occurred in one case due to aortobronchial fistula with continuing backflow from distal ARSAA and previous TEVAR. At computed tomography controls, 1 type I and 1 type II endoleak were detected; the latter required a sacotomy reintervention. ARSAA-related death was statistically more frequent after TEVAR, a procedure reserved for ruptures, compared with open or hybrid repairs (P = .01). Conclusions Hybrid repair is the preferred therapeutic option for patients presenting with ARSAA. Midterm results show high rates of clinical success with low risk of reintervention. Simple endografting presents high risk of related death. These findings underline the importance of achieving complete sealing, to avoid treatment failures.
Results of Aberrant Right Subclavian Artery Aneurysms Repair: A Contemporary Multicenter Experience
Fabio Verzini
Conceptualization
;Giacomo IserniaInvestigation
;Gioele SimonteInvestigation
;Paola De RangoInvestigation
;Piergiorgio CaoInvestigation
2014
Abstract
Objectives To review current choices and late results of aberrant right subclavian artery aneurysms (ARSAA) repair. Methods All consecutive ARSAA repairs from 2006 to 2013 in seven centers were reviewed. End points were 30-day and late mortality, reintervention rates, and ARSAA-related deaths. Results Included were 21 ARSAA repairs (57% males; mean age, 67 years). Three ruptures (14%) required emergency treatment, and 12 (57%) were symptomatic for dysphagia (33%), dysphonia (24%), and pain (19%). Eight cases presented thoracic aortic aneurysm, two with intramural hematomas, and one with acute type B aortic dissection. Mean ARSAA diameter was 42 mm; a single bicarotid common trunk was present in 38% of cases. Most patients received hybrid procedures (71%), consisting of single (two cases), bilateral (12 cases) subclavian-to-carotid transposition or bypass, or ascending aorta to subclavian by pass (one case) plus thoracic endografting (thoracic endovascular aortic repair [TEVAR]); 19% of cases underwent open repair and 9% simple TEVAR with ARSA overstenting. Perioperative death occurred in two patients (9%): in one case after TEVAR in ruptured ARSAA, requiring secondary sternotomy and aortic bending, and due to multiorgan failure after a hybrid procedure in an elective case. Mean follow-up was 31 ± 20 months. Estimates of Kaplan-Meier 36-month survival was 90%. Late ARSAA-related death occurred in one case due to aortobronchial fistula with continuing backflow from distal ARSAA and previous TEVAR. At computed tomography controls, 1 type I and 1 type II endoleak were detected; the latter required a sacotomy reintervention. ARSAA-related death was statistically more frequent after TEVAR, a procedure reserved for ruptures, compared with open or hybrid repairs (P = .01). Conclusions Hybrid repair is the preferred therapeutic option for patients presenting with ARSAA. Midterm results show high rates of clinical success with low risk of reintervention. Simple endografting presents high risk of related death. These findings underline the importance of achieving complete sealing, to avoid treatment failures.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
