Cervical Debranching in the Endovascular Era: A Single Centre Experience

Objective/Background Debranching of the supra-aortic arteries is a common practice either as part of a hybrid treatment of aortic arch pathology or owing to arterial occlusive disease. Results of the debranching techniques have not been reported frequently. Methods This was a retrospective single centre study of all consecutive patients with cervical debranching procedures as part of hybrid aortic arch repair. Results Between 2010 and 2017, 201 patients underwent 211 cervical debranching procedures in a tertiary centre. Mean ± SD patient age was 67.7 ± 10.7 years (70.6% males; n  = 142/201) and mean ± SD body mass index (BMI) was 26.3 ± 5. In 78.7% of the cases carotid–subclavian bypass was performed alone ( n  = 166/211) followed by transposition of the subclavian artery to the ipsilateral carotid ( n  = 17/211; 8.1%) and in 28 cases (13.3%) a combination of procedures was performed. Twenty-four cases (11.4%) were complicated with local bleeding and 21 cases required re-intervention (10.4%). Nineteen patients (9.5%) developed local peripheral neurological damage post-operatively. Eight patients (3.8%) developed a chylous fistula and five (2.4%) presented with a local wound infection. One patient (0.5%) developed a bypass graft infection. The thirty day mortality was 7.6% ( n  = 16/211): one death occurred after isolated debranching without thoracic endovascular aneurysm repair (TEVAR; 0.5%). Whether the hybrid procedures were undertaken in a single stage (simultaneous TEVAR and cervical debranching) or two stage fashion appeared to have a significant impact on 30 day mortality (single stage n  = 9/60 [15%] vs. debranching alone or two stage hybrid procedures n  = 7/144 [4.9%]; p  = .018). The major stroke incidence was 4.3% ( n  = 9/211); no strokes occurred after isolated debranching. Stroke was correlated with longer operating times (odds ratio [OR] 1.006; 95% confidence interval [CI] 1.000–1.011; p  = .045) and higher BMI (OR 1.195; 95% CI 1.009–1.415; p  = .039). Mean ± SD follow up was 15 ± 17 months (range 0–89 months). Primary cumulative graft patency during follow up was 98.1% (n = 207/211) and secondary patency was 100%. Conclusion The results of cervical debranching procedures showed not only excellent patency rates, but also a significant rate of local complications. Carotid–subclavian bypass appeared to be safer with significantly fewer post-operative complications. Staged hybrid procedures also seemed to be safer.