Debranching with thoracic endovascular aortic repair for treating aortic arch lesions: a retrospective single-center experience

Background: Hybrid aortic arch repair combining debranching surgery with thoracic endovascular aortic repair (TEVAR) addresses complex aortic arch lesions. This study evaluated the long-term outcomes of hybrid aortic arch repair combining debranching surgery with TEVAR. Methods: We retrospectively analyzed 41 consecutive patients (mean age 56.9±14.6 years) undergoing hybrid arch repair between January 2010 and January 2021. Lesions included aneurysms (n=17), dissections (n=21), penetrating aortic ulcers (n=2), and intramural hematomas (n=1). Patients were stratified by proximal landing zones: zone 0 (n=8), zone 1 (n=12), and zone 2 (n=21). Primary endpoints were technical success, 30-day mortality, and long-term survival. Secondary endpoints included endoleak rates, bypass patency, and major complications. All patients underwent simultaneous hybrid surgery. Results: Technical success was achieved in all cases (100%). Early complications included type I endoleaks (4.8%, managed conservatively), severe pneumonia (14.6%), and incision hematomas (9.8%). The 30-day mortality was 2.4% (1/41, myocardial infarction). During a mean follow-up of 62.6 months, bypass graft occlusion occurred in 5 patients (4/5 axillary, 1/5 subclavian grafts, 12.8%). The 1-, 3-, and 5-year survival rates were 94.9%, 92.3%, and 84.6%, respectively, with no significant differences among landing zones (P=0.72). Axillary bypasses showed inferior patency compared to carotid-based reconstructions. Conclusions: Hybrid arch repair achieves favorable long-term outcomes with low mortality and stroke rates. Anatomical landing zone selection did not affect survival, but axillary bypasses demonstrated poorer durability. These findings support hybrid strategies for high-risk patients, with preferential use of carotid-based reconstructions to optimize bypass longevity.