Comparative Analysis of Endovascular and Open Debranching in Thoracic Aortic Arthroplasty

INTRODUCTION The rapid development of endovascular surgery, vascular surgery, as well as the improvement of visualization methods leads to an increase in the incidence and number of operations on different parts of the aorta, in particular the aortic arch.

THE AIM of our study was to compare the results of different types of debrunching.

MATERIAL AND METHODS In the period from 2015 to 2023, 96 patients with aortic arch lesion were operated on using the endovascular method in several medical organizations. A multicenter retrospective comparative study was conducted among patients with endovascular (n=76) and open (n=20) debranching during thoracic aortic endoprosthetics (TAE). The average follow-up time for patients was 32±22 months. Carotid-subclavian bypass and fenestrated on-table and in-situ stent grafts were used for debranching. The following patient characteristics were used in the comparative analysis in the groups: mean age, body mass index, gender, comorbidity. Also, operational parameters: surgery time, blood loss volume, contrast, surgery urgency, number of endoleaks. Subsequently, the results of the operations were analyzed: the number of hospital days, complications, repeated interventions, mortality rates (in-hospital, long-term).

RESULTS Technical success in both groups was 100%. The operation time was statistically significantly shorter in the endovascular debranching group 173.3±83.8 minutes (p=0.0002), the volume of blood loss was statistically significantly lower in the endovascular debranching group 87.4±48.7 ml (p=0.0001), the consumption of contrast agent was statistically significantly higher in the endovascular debranching group 233.1±93.38 ml (p<0.0001), the endovascular debranching group had significantly more planned surgeries (p=0.0005), the number of endoleaks without statistically significant difference (p=0.67). Endovascular debranching statistically significantly reduces the time of hospitalization by 4.5 days p=< 0.0001. There was no statistically significant difference in the rates of complications and re-interventions (p=0.3294, p=0.1618, respectively). There was no statistically significant difference in the analysis of hospital and long-term mortality (p=0.11, p=0.65).

CONCLUSION Endovascular debranching reduces the time of surgery, the volume of blood loss, and the number of days spent in hospital. There are no statistically significant differences between the groups when analyzing endoleaks, repeated interventions, and complications. No statistically significant difference was found when analyzing mortality (in-hospital, long-term).

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