Endovascular Treatment of Brachiocephalic Trunk Aneurysms: a Systematic Review

Abstract

INTRODUCTION: Brachiocephalic trunk aneurysms are rare, usually secondary to atherosclerosis, trauma or iatrogenic interventions. Although open surgical repair is still considered first choice, endovascular treatment options have become increasingly more common. The purpose of this review was to provide an overview of published evidence regarding the efficacy and safety of endovascular treatment in patients with brachiocephalic trunk aneurysms. EVIDENCE ACQUISITION: A systematic review was designed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Primary outcomes included peri-operative and long-term death. Secondary outcomes were hospitalization time, symptom resolution/relief, stent-graft migration, stent-graft patency and endoleak occurrence during follow-up. EVIDENCE SYNTHESIS: A total of 33 articles were included in the qualitative analysis, with 42 cases described. Two patients died, at 115 days and 2 months of follow-up (mortality rate of 4.8%); Mean post-operative hospitalization period was 9.7 days; Resolution/relief of symptoms was reported in 20 of the 22 symptomatic patients (91%). Additionally, there were no reports of new-onset neurological deficits, cerebral or upper limb ischemia and infection following the procedures. No patients presented stent-graft migration or obstruction during follow-up; However, type I endoleak occurred in 7% of patients. CONCLUSIONS: Endovascular treatment of brachiocephalic trunk aneurysms has shown promising results, both in terms of efficacy and safety. Nevertheless, available evidence is still limited, so additional data from future research are needed, ideally in the form of larger registry studies or randomized controlled trials.