Long-Term Results of Endovascular Repair for Distal Arch and Descending Thoracic Aortic Aneurysms Treated by Custom-Made Endografts: Usefulness of Fenestrated Endografts

• Published in: Annals of Vascular Diseases Vol. 7; no. 4; pp. 383 - 392
• Main Authors: Matsuyama, Masakazu, Nakamura, Kunihide, Nagahama, Hiroyuki, Nina, Katsuhiko, Endou, Jouji, Kojima, Kazushi, Nishimura, Masanori, Ishii, Hirohito, Yokota, Atsuko
• Format: Journal Article
• Language: English
• Published: Japan The Editorial Committee of Annals of Vascular Diseases 01.01.2014
• Subjects: custom-made; distal arch aneurysm; fenestrated endograft; long-term results; Original; thoracic aortic aneurysm; custom-made; fenestrated endograft; thoracic aortic aneurysm; long-term results; distal arch aneurysm
• ISSN: 1881-641X; 1881-6428
• DOI: 10.3400/avd.oa.14-00057

Objective: We evaluated early and long-term results of atherosclerotic aneurysm repair with custom-made endografts.Materials and Methods: Eighty-one consecutive patients underwent thoracic endovascular aortic repair with custom-made endografts. Fenestrated grafts were used in 37 patients (45.7%) to maintain blood flow of the neck and a landing zone for as long as possible for distal arch or proximal descending aneurysms. The rates of perioperative mortality, stroke, paraplegia, and primary endoleaks were assessed to evaluate in-hospital safety. The rates of endoleak development, survival, and freedom from aortic-related death were assessed to evaluate long-term efficiency.Results: Twenty-four patients (29.6%) underwent urgent operations, and 38 (46.9%) underwent distal arch or proximal descending aortic aneurysm repair. There was one case (1.2%) of in-hospital mortality and no cases of stroke. Permanent spinal injury occurred in one patient (1.2%). Early and late endoleaks occurred in one and 16 patients, respectively. The actuarial survival rates were 88.9%, 64.9%, and 51.7% at 1, 5, and 10 years, respectively. The actuarial rates of freedom from endoleaks were 90.1%, 81.3%, and 68.6% at 1, 5, and 10 years, respectively.Conclusion: Early results of custom-made endografts were excellent, and fenestrated endografts were safe for distal arch and proximal descending aortic aneurysms.