Chimney Stenting Versus Surgical Debranching for Treatment of Aortic Arch Pathologies - A Propensity Matched Analysis

Objective: Endovascular repair of aortic arch lesions requires revascularization of epi-aortic vessels in case of coverage. The objective of this study was to compare the outcomes of surgical bypass versus endovascular reconstruction with a chimney graft.

Methods: A retrospective analysis of a multicentre register between January 2005 and December 2019 was performed. A total of 127 patients were included and divided into 2 groups: TEVAR+surgical debranching (n= 72) and TEVAR+chimney stenting (n=55). Main endpoints were major neurologic sequelae and type I A endoleak. Propensity score matching was performed to analyse baseline variables related to these outcomes.

Results: Mean follow-up was 35,6 months for the debranching group and 34,1 for the chimney group (P= 0.65). The incidence of stroke was higher in the chimney group, although not statistically significant (7,3% vs 4,1%; P = 0.46); for both groups a wide angle between the ostium of the target vessel and the aorta and landing in Ishimaru Zone 0 were found to be the main predictors for major neurologic sequelae (P=0.002 and P=0.003 respectively). During follow-up, 9 (12,5%) Type I A endoleaks occurred in the debranching group and 12 (21,8%) in the chimney group (P = 0.14). Aortic diameter larger than 66mm and arch angle > 46° had a strong association with proximal endoleak incidence (P=0.001 and P=0.011 respectively) CONCLUSIONS: Surgical debranching showed better results than chimney stenting in terms of major neurologic events incidence and Type I A endoleak, although the difference between the groups was not statistically significative. Further research with larger cohorts is needed to establish the indications for these procedures.