Extra-anatomical left common carotid and subclavian artery bypass followed by thoracic endovascular aortic repair: a cohort study

Introduction: Thoracic endovascular aortic repair (TEVAR) is the preferred strategy for treating descending aortic disease.However, aortic arch involvement remains challenging, especially in proximal landing zones (0, 1, or 2), due to the presence of supra-aortic trunks.Hybrid techniques combining supra-aortic debranching with TEVAR offer an alternative to open surgery.Objective: To describe the experience and outcomes of patients undergoing supra-aortic debranching followed by TEVAR at a tertiary care cardiovascular center in Colombia.Methods: A retrospective cohort study (2021-2023) was conducted, including patients who underwent supra-aortic debranching followed by TEVAR.Clinical characteristics, procedural details and outcomes, including complications, mortality, and reinterventions, were analyzed.Shapiro-Wilk, Kruskal-Wallis, and Chi-squared/Fisher's exact tests were used, as applicable.Results: A total of 21 patients were included (mean age: 70.71 years, SD ±12.21).The most common comorbidities were chronic kidney disease (61.90%), diabetes (61.90%), and dyslipidemia (66.66%).The most frequently performed procedure was left subclavian-carotid debranching (52.38%).Major complications included pneumonia (52.38%), atrial fibrillation (28.57%), and myocardial infarction (38.09%).No mortality was reported at 6, 12, or 24 months.Conclusions: Supra-aortic debranching followed by TEVAR demonstrated high patency rates, technical success, and favorable survival outcomes.It remains a viable alternative in centers without access to advanced endovascular technologies.