title: Thoracic endovascular aortic repair with aortic arch vessel revascularization.
abstract: BACKGROUND
  Revascularization of aortic arch vessels was performed with thoracic endovascular aortic repair (TEVAR) to preserve the endoprosthesis landing zone in 19 high-risk patients.
  
  
  METHODS
  The operative procedure used was a bypass or transposition involving the common carotid and subclavian arteries. Homemade fenestrated stent-grafts, deployed in landing zone 0, were used for TEVAR.
  
  
  RESULTS
  All lesions resolved without endoleaks. No perioperative deaths occurred; seven patients had postoperative complications. One patient with acute respiratory distress syndrome required reoperation to change the bypass route and permit tracheostomy. One patient died of pneumonia 2 months after treatment, after an anastomotic pseudoaneurysm and cerebral infarction developed and an operation was performed to obtain hemostasis. The procedure-related mortality was 5.3%.
  
  
  CONCLUSIONS
  Aortic arch vessel revascularization before TEVAR may permit less invasive surgery, although careful patient selection is essential.
authors.affiliation: Department of Vascular Surgery, Tokyo Medical University, Tokyo, Japan. y.iida@vanilla.ocn.ne.jp
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Iida
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kawaguchi
authors.forename: Nobusato
authors.initials: N
authors.lastname: Koizumi
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Komai
authors.forename: Yukio
authors.initials: Y
authors.lastname: Obitsu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shigematsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome