Long Term Outcomes of Zone 2 Thoracic Endovascular Aortic Repair with Branched Endoprosthesis or Carotid-Subclavian Bypass: A Propensity Matched Study.

Abstract

Revascularisation of the left subclavian artery (LSA) in zone 2 thoracic endovascular aortic repair (TEVAR) is traditionally performed with carotid-subclavian (CS) bypass. A thoracic branch endoprosthesis (TBE) has been developed for endovascular LSA revascularisation during zone 2 TEVAR. This single centre, retrospective cohort study aimed to compare the short and long term outcomes of TBE with TEVAR with CS bypass (CS-TEVAR) in patients requiring zone 2 arch repair. One hundred and seventy-two patients underwent zone 2 CS-TEVAR and 66 patients underwent zone 2 TBE from January 2014 to May 2023. The primary outcome was in hospital death; long term outcomes included survival and freedom from type 1a or 1c endoleak. Propensity score matching identified 55 pairs of patients with similar baseline characteristics. Kaplan-Meier curves were plotted for long term survival on clinical follow up and endoleak on imaging follow up. Mean clinical follow up for the entire cohort was 3.5 ± 2.6 years. Technical success was 100%. In the propensity score matched cohort, there was no difference in in hospital death (1.8% vs. 1.8%; p = 1.0) or stroke (3.6% vs. 5.5%; p = .65) between TBE and CS-TEVAR. There was no difference in survival at 6 years (67.0 ± 10.0% vs. 76.0 ± 7.9%; p = .21). TBE patients had statistically significantly higher freedom from type 1a or 1c endoleak (97.9 ± 2.1% vs. 87.3 ± 4.9%; p = .04) on imaging follow up at 6 years. TBE demonstrated comparable short and long term outcomes compared with CS-TEVAR and is a reasonable alternative for zone 2 arch repair in suitable patients.