title: [Strategies for handling the insufficiency of the proximal landing zone during endovascular thoracic aortic repair].
abstract: OBJECTIVE
  To discuss two strategies for handling the insufficiency of the proximal landing zone (PLZ) during endovascular thoracic aortic repair.
  
  
  METHODS
  Ten patients underwent endovascular repair (EVR) in the thoracic aorta in one year. Nine patients had DeBakey type III aortic dissection aneurysm (ADA), and one had descending thoracic aortic aneurysm (DTAA). The PLZ, defined as the distance from the origin of the left subclavian artery (LSA) to the primary entry tear of the dissection or the proximal aspect of DTAA, was measured less than 15 mm in all instances by contrast-enhanced CT scan and digital subtraction angiography. The preliminary carotid-carotid and left carotid-subclavian bypass combined with EVR was employed in the DTAA and 3 ADA cases, and the EVR with the intentional coverage of the LSA without the preliminary bypass in the rest 6 ADA patients.
  
  
  RESULTS
  The technical success was achieved in all instances. The case of DTAA died of the hemispheric cerebral infarction and subsequent multiple system organ failure, albeit the uneventful recovery from the prior cervical reconstruction. Dizziness occurred in 2 patients (ADA) after the EVR with the intentional bypass-absent coverage of the LSA, but noticeably resolved after the intravenous administration of mannitol for 4 to 5 days. No neurological deficits or limb ischemia developed perioperatively or during the follow-up range from 3 to 12 months. And complete thrombosis of the thoracic aortic false lumen and enlargement of the true lumen were revealed on CT at 3 months in all 9 patients with ADA.
  
  
  CONCLUSIONS
  Both the adjunctive surgical bypass and the intentional bypass-absent coverage of the left subclavian artery appear feasible in handling the insufficiency of the proximal landing zone during the endovascular thoracic aortic repair. It can expand the EVR applicability in management of DeBakey type III ADAs and DTAAs.
authors.affiliation: Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Zhi-hui
authors.initials: ZH
authors.lastname: Dong
authors.forename: Wei-guo
authors.initials: WG
authors.lastname: Fu
authors.forename: Yu-qi
authors.initials: YQ
authors.lastname: Wang
authors.forename: Da-qiao
authors.initials: DQ
authors.lastname: Guo
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
authors.forename: Bin
authors.initials: B
authors.lastname: Chen
authors.forename: Jun-hao
authors.initials: JH
authors.lastname: Jiang
authors.forename: Jue
authors.initials: J
authors.lastname: Yang
authors.forename: Zhen-yu
authors.initials: ZY
authors.lastname: Shi
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D017536:Carotid Artery, Common / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*