title: Avoidance of proximal endoleak using a hybrid stent graft in arch replacement and descending aorta stenting.
abstract: BACKGROUND
  In complex thoracic aortic procedures, proximal repair and antegrade stent grafting of the descending aorta is an emerging technique to achieve one-stage treatment of the thoracic aorta. To overcome problems of proximal endoleak, a hybrid stent graft was designed and used. This study assessed technical feasibility and early results.
  
  
  METHODS
  From Jan 2005 to May 2008, 41 patients (age, 60 +/- 13 years) comprising 35 aortic dissections (AD) and 6 aortic aneurysms underwent arch replacement and antegrade stent grafting of the descending aorta using the hybrid stent graft. Endoleaks were evaluated by computed tomography (CT) scans. In AD cases, the false lumen (FL) was evaluated with CT volume measurements.
  
  
  RESULTS
  Combined arch replacement and antegrade stent grafting was technically successful. One proximal endoleak was observed, which was not related to the hybrid prosthesis (40 of 41, 98%). Three patients died (7%). No paraplegia occurred. Incidence of immediate FL thrombosis was 97% at the proximal and 80% at the distal stent graft level. During follow-up (17 +/- 11 months), complete thrombosis of the perigraft space was 91%. FL volume shrinkage was documented (p < 0.01). No perfusion of the perigraft space was observed in aneurysm cases. Intermediate survival was 33 of 38 (87%).
  
  
  CONCLUSIONS
  One-stage repair of complex thoracic aortic disease using a hybrid stent graft can be reliably performed with low hospital mortality. Proximal endoleak can be definitely avoided; in AD, exclusion and ongoing significant shrinkage of the FL can be achieved.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University Hospital Essen, Essen, Germany. konstantinos.tsagakis@uk-essen.de
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsagakis
authors.forename: Markus
authors.initials: M
authors.lastname: Kamler
authors.forename: Hilmar
authors.initials: H
authors.lastname: Kuehl
authors.forename: Wojciech
authors.initials: W
authors.lastname: Kowalczyk
authors.forename: Paschalis
authors.initials: P
authors.lastname: Tossios
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
authors.forename: Brigitte
authors.initials: B
authors.lastname: Osswald
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000601:surgery; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000517:prevention & control*; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D015607:Stents; D013927:Thrombosis / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed