Stephen WK Cheng
Current Position
Serena HC Yang Professor of Vascular Surgery, Head, Department of Surgery
The University of Hong Kong
Thoracic Aorta Session

Topic: Update of endovascular branched graft in aortic arch repair


Endovascular repair of aortic arch pathology using branched endografts has matured over the years. The main concerns revolved around custom designs, need for extra-anatomical bypasses, blood pressure control, and periprocedural stroke. Inner side branch endografts design had been standardized and evolving to be off the shelf products. The main challenges in delivery are the relatively large delivery system, the diameter and angulation of the proximal landing zone, landing in prosthetic ascending aorta and prosthetic heart valves. Blood pressure control either via rapid pacing or IVC occlusion has matured to produce good results.
Current advances are towards a three-inner-branch arch endograft system. Initial studies focused on three different designs with close to 80% suitability. Technique wise a total endovascular approach without the need for carotid puncture has been proven feasible. With experience in larger volume centers the stroke risks had diminished substantially. The indications in treating dissections remained controversial. Long term results on aneurysm shrinkage and branch patency remained to be proven.
In Queen Mary Hospital we had performed 28 arch inner side branch (double and triple) using both the Cook and Termuo devices, with a mean patient age of 78 years, 21% on dissections. The 30-day mortality was 10.7% and procedural stroke 10.7%. There was one reintervention and one aneurysm related long term mortality.
Arch endografts is a proven option for high surgical patients with good anatomy, and may be considered a viable alternative to total arch replacement for medium to lower risk patients.