title: Thoracic aortic lesions treated with the Zenith TX1 and TX2 thoracic devices: intermediate- and long-term outcomes.
abstract: OBJECTIVE
  Little data exist to support the durability of thoracic endovascular repair during prolonged periods of follow-up. This study examines the durability and long-term results with the Zenith TX1 and TX2 thoracic devices (Cook Inc, Bloomington, Ind) in high-risk patients.
  
  
  METHODS
  Data were collected prospectively from 2001 to 2007 on high-risk patients who presented with thoracic aneurysms, chronic aortic dissection, or fistulas treated with a Zenith thoracic device. Surgical modifications of proximal or distal landing zones were performed when necessary. Computed tomography follow-up scans were performed before discharge, at 1, 6, and 12 months, and yearly thereafter. Three-dimensional reconstruction software with central line of flow measurements was used to assess aortic morphologic characteristics. Kaplan-Meier analysis was used to assess survival, freedom from reintervention, predictive factors of poor outcome, and morphologic changes, including aneurysm sac behavior.
  
  
  RESULTS
  A total of 160 patients (44% women; mean age, 70) were treated for 130 thoracic aneurysms, 25 aortic dissections with aneurysm, 2 fistulas, and 3 symptomatic or aortic ruptures, or both. Mean follow-up was 36 months, and aneurysm size was 67 mm. Seventy-five patients (47%) had undergone prior aortic aneurysm repair. Surgical modifications were required to create adequate landing zones in 33% patients, including 28 elephant trunk/arch reconstruction, 22 carotid-subclavian bypasses, and seven visceral vessel bypasses. Iliac conduits were required in 31 patients. Early mortality (<30 days) occurred in 11 patients (6.9%). Overall mortality at 1 year was 16%. Aneurysm sac increase (>5 mm) requiring intervention was observed only in one patient in the settings of component separation and type III endoleak that was treated; the sac is now stable. Twenty-seven endoleaks were detected in 25 patients: 15 primary endoleaks (9.4%) <30 days and 12 secondary endoleaks (7.5%) >30 days. Secondary interventions were required in 42 patients (26%).
  
  
  CONCLUSIONS
  Endovascular treatment of thoracic aortic pathologies with the Zenith TX1 and TX2 devices is feasible and durable. The mid- to long-term results are encouraging, with acceptable low reintervention rates and with good survival within high-risk patients.
authors.affiliation: Department of Vascular and Endovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Jose P
authors.initials: JP
authors.lastname: Morales
authors.forename: Roy K
authors.initials: RK
authors.lastname: Greenberg
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Morales
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cury
authors.forename: Adrian V
authors.initials: AV
authors.lastname: Hernandez
authors.forename: Sean P
authors.initials: SP
authors.lastname: Lyden
authors.forename: Daniel
authors.initials: D
authors.lastname: Clair
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D015993:Life Tables; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency