PURPOSE: Endovascular thoracic aortic repair (TEVAR) is performed widely over the past several years. However, some patients are not candidates for TEVAR because of unsuitable anatomy for manufactured stent graft, for example inadequate proximal landing zone on the ascending aorta and aortic arch. We experienced 10 cases for treatment of distal arch aneurysms used the homemade fenestrated stent graft for preserved arch vessels. We report endovascular repair for distal aortic arch aneurysms using homemade fenestrated stent grafts.
METHODS: Between Jan 2008 and March 2011, 10 patients underwent TEVAR for distal arch aneurysms using fenestrated stent grafts at our medical center. Preoperative imaging was obtained with computed tomography angiography (CTA). Stent graft designed individually under the preoperative CTA. The device consists of a stainless steel cage within a thin walled polyetrafluoroethylene (ePTFE) graft. The thin wall graft allows the prosthesis to be delivered original catheter. Procedures were performed in an operating room with mobile 13-inch C-arm. All procedures performed under the general anesthesia. The stent grafts were placed in Zone 0 through open common femoral artery access using tag of wire technique.
RESULTS: Initial technical success was obtained in all patients. Three cases performed right subclavian to left subclavian artery bypass before TEVAR in order to need coverage left common carotid artery or left subclavian artery obtained proximal landing zone. The 30-days mortality rate was 0%. There were no cases that had cerebral infarction and paraplegia. Postoperative CTA revealed type II endoleak in two patients and no type I endoleak. No aneurysms ruptured or required open conversion during the follow-up period.
CONCLUSIONS: The use of homemade fenestrated stent grafts for distal aortic arch aneurysms provides a minimally invasive alternative to open surgery. This device can be extended proximal landing zone into Zone 0. Long-term follow-up is needed to better understand the durability of this device.
CLINICAL IMPLICATIONS: .
DISCLOSURE: The following authors have nothing to disclose: Hiroaki Yusa, Takashi Azuma, Yoshihiko Yokoi, Kenji Yamazaki
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