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Staged thoracic endovascular aortic repair of extensive aortic arch aneurysm
akihrio yoshitake, Kazuma Okamoto, Ichiro Kashima, Mio Kasai, Akinori Hirano, Yuuta Akamatsu, Hidenori Oka, Takayuki Kawashima, Hiroto Kitahara, Hideyuki Shimizu.
Keio University, shinjyuku, tokyo, Japan.

OBJECTIVE: Extensive aortic arch aneurysms (ascending aorta, aortic arch, and descending aorta) require innovative surgical techniques. We adopted two -staged procedure, open total arch replacement with elephant trunk as a first stage and thoracic endovascular aortic repair (TEVAR) as second stage, for elective repair of extensive aortic arch aneurysms.The objective is to evaluate the perioperative and mid-term results of staged TEVAR to extensive aortic arch aneurysms.
METHODS: Between January 2009 and September 2015, we planed staged TEVAR in 42 patients with a mean age of 70.6. Of these, all the patients were treated with total arch replacement with elephant trunk procedures as first stage. Second stage (TEVAR) was completed in 40 of 42 (95.2%) patients. Median duration between two stages was 2 months (range: 0-22 months).
RESULTS: There was no hospital mortality at first stage and second stage. Mortality rate during the interval between first stage and second stage was 4.9%(2 of 41), of which one patient died on 2 months after first stage and the other on 11 months after first stage operation due to aneurysm rupture. One of 42 (2.4%) first stage patients had stroke. No stroke occurred in second stage. No spinal cord dysfunction occurred both in first and second stages. The cumulative survival rate was 100% and 84.8% at 1 and 3 years, respectively. Freedom from arotic related reoperation rate was 97.0% and 93.6% at 1 and 3 years, respectively.
CONCLUSIONS: Extensive aortic aneurysms can be treated with acceptable morbidity and mortality rates through the use of staged TEVAR. After staged TEVAR was performed, patients have acceptable mid term survival.


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