Objective To explore the early and midterm outcomes of treating aortic arch disease with multiple parallel stent grafts (MPSGs) in patients deemed high risk for open surgery.

Methods To analyze the clinical data of 27 patients with aortic arch diseases treated by multiple parallel stents combined with thoracic aortic endovascular repair in the Department of Vascular Surgery of Zhongshan Hospital, Fudan University from February 2011 to August 2018.

Results A total of 27 patients (mean age, 50.8±10.1 years; 20 men) underwent TEVAR with MPSGs. Pathologies included thoracic aortic aneurysm (n=10), type B aortic dissection with retrograde dissection (n=7), post-TEVAR type Ⅰ endoleak (n=4), aortic arch dissected aneurysm postsurgical repair (n=3), and anastomotic pseudoaneurysm (n=3). Seventeen and ten patients had disease in aortic arch zone 0 and 1, respectively. Technical success was achieved in all patients. Intraoperative type Ⅰ endoleak was observed in 10 patients (37.0%). No major morbidity or mortality occurred perioperatively. The median follow-up duration was 24.2 months (range, 3-92), during which time 3 patients required an aortic-related reintervention. The overall mortality rate was 11.1% (3/27). The estimated 2- and 4-year survival rates were 92.4% ±5.6% and 83.2% ±11.7%, respectively. The estimated rates of freedom from endoleak at 2 and 4 years were 84.4% ±9.4% and 75.9% ±14.1%, respectively.

Conclusions TEVAR with MPSGs is feasible for the treatment of aortic arch disease in high-risk patients unsuitable for open surgery. Additional evidence and studies with larger sample size and longer follow-up are required to standardize this technique and support its durability.