title: Endovascular treatment of acute thoracic aortic syndromes with a proximal landing zone extension strategy: procedural and follow-up results.
abstract: OBJECTIVE
  To report the procedural and long-term follow-up data (mean, 43 ± 29 months; range, 12-90 months) of endovascular stent grafting (ESG) of acute thoracic aortic syndromes (ATAS) with a proximal landing zone extension strategy.
  
  
  METHODS
  From November 1999 to May 2008, 26 patients (25 males, 1 female; mean age, 57.9 ± 17 years) with ATAS underwent ESG at our institution. Underlying pathologies were: penetrating aortic ulcer (n=7); rupture of a descending aorta aneurysm (n=5), post-traumatic false aneurysm (n=5); acute type B dissection (n=6) and traumatic descending aorta transection (n=3).
  
  
  RESULTS
  ESG was performed successfully in all patients. In 5 patients (19%), an extra-anatomic revascularization of the supra-aortic vessels was performed. In 19 patients (73%), overstenting of the left subclavian artery, without preliminary revascularization, was performed. The mean proximal landing zone length was 57 ± 19 mm. No intraprocedural deaths occurred; 3 patients died postoperatively (1 from an unrelated cause, 1 from a myocardial infarction and 1 for the sequelae of an ischemic stroke). One patient underwent cardiac surgery for post-procedural retrograde type-A dissection. Follow up involved a computed tomography (CT) scan at 1, 3, 6 and 12 months, then yearly thereafter. At follow up, no deaths or major complications occurred. The CT scans revealed 1 small type-IB endoleak at 1 year.
  
  
  CONCLUSIONS
  In ATAS patients treated with ESG, the extension of the proximal landing zone, despite the need of subclavian coverage or hybrid procedures, is associated with an immediate procedural outcome and low morbidity at follow-up.
authors.affiliation: Department of Cardiology, Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Via Aurelia Sud 54100, Massa, Italy. vaghetti@ifc.cnr.it
authors.forename: Marco
authors.initials: M
authors.lastname: Vaghetti
authors.forename: Cataldo
authors.initials: C
authors.lastname: Palmieri
authors.forename: Anees
authors.initials: A
authors.lastname: Al-Jabri
authors.forename: Marcello
authors.initials: M
authors.lastname: Ravani
authors.forename: Antonio
authors.initials: A
authors.lastname: Rizza
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Trianni
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mariani
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
authors.forename: Roberto
authors.initials: R
authors.lastname: Troiani
authors.forename: Dante
authors.initials: D
authors.lastname: Chiappino
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000601:surgery; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013577:Syndrome; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D014456:Ulcer / Q000601:surgery; D058017:Vascular Grafting / Q000379:methods*