Off-Label Treatment With Transfemoral Bare Stents for Isolated Aortic Arch Dissection

Background. Aortic arch dissection is a catastrophic acute event involving the aorta. Its accurate diagnosis and treatment are mandatory to optimize patient outcome. We aimed to assess the efficacy and safety of endovascular treatment with transfemoral bare stents of isolated aortic arch dissection as a valid alternative in patients unsuitable for conventional surgery. Methods. In this case series, we report our experience with 3 patients affected by isolated aortic arch dissection treated with endovascular surgery from February 2019 to May 2019. All patients were associated with severe comorbidities emergently referred at our center. Vascular access was achieved by surgical exposure of the right common femoral artery performed under general anesthesia. All patients were observed for at least 3 months. Results. All patients were treated in a hybrid operative room with transfemoral implantation of a bare metal Jotec E-XL stent released in the aortic arch. The postoperative period was uneventful, and all 3 patients were discharged or transferred on the fourth postoperative day. At follow-up, computed tomography scans showed good results in all patients. Conclusions. A purely endovascular approach to located aortic arch dissections, with bare stents, remains challenging, although it has been proven to be a valid alternative treatment in some off-label cases. (Ann Thorac Surg 2021;111:1325-30) (c) 2021 by The Society of Thoracic Surgeons

Automated summary

This study presented experiences in treating isolated aortic arch dissection with bare stents in three patients, showing good postoperative results and smooth recovery. A purely endovascular approach with bare stents remains challenging but effective in selected cases.