title: Thoracic endografting reduces morbidity and remodels the thoracic aorta in DeBakey III aneurysms.
abstract: BACKGROUND
  The efficacy of endovascular treatment of aneurysms secondary to chronic DeBakey type III aortic dissection (CD3) remains controversial. The objective of this study was to compare outcomes from open and endovascular treatment of CD3 aneurysms, and to determine the efficacy of thoracic endovascular aortic repair (TEVAR) in remodeling the chronically dissected thoracoabdominal aorta.
  
  
  METHODS
  From 2005 to 2012, 58 patients underwent open aortic replacement (open) and 31 patients underwent endovascular therapy (TEVAR) for the treatment of CD3 aneurysms. The TEVAR patients were divided into CD3a (n = 12) or CD3b (n = 19) subgroups based upon the DeBakey classification of aortic dissection. Total aortic, true and false lumen diameters were measured at different anatomic locations. True lumen and false lumen indices were calculated to evaluate the impact of TEVAR on remodeling.
  
  
  RESULTS
  In the open group, operative mortality was 10.3% and the incidence of pulmonary failure, renal failure, and paraplegia was 13.8%, 10.3%, and 12.1%, respectively. There were no operative mortalities in TEVAR patients, and no cases of pulmonary failure, renal failure, or paraplegia. Endovascular therapy stabilized aneurysm size and remodeled the thoracic aorta in 87% of patients. The TEVAR significantly expanded the true lumen and reduced the false lumen within the stent graft in CD3a and CD3b patients (p < 0.001). Thoracic false lumen thrombosis was achieved in 100% of CD3a and in 68% of CD3b patients.
  
  
  CONCLUSIONS
  In these early results, TEVAR reduces operative morbidity and mortality compared with open aortic replacement in the treatment of CD3 aneurysms. The TEVAR is effective in remodeling the chronically dissected thoracic aorta. Abdominal false lumen patency is maintained in patients with thoracoabdominal dissection-related aneurysms.
authors.affiliation: Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Leshnower
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.forename: Alberto
authors.initials: A
authors.lastname: Pochettino
authors.forename: Nimesh D
authors.initials: ND
authors.lastname: Desai
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Moeller
authors.forename: Derek P
authors.initials: DP
authors.lastname: Nathan
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Jackson
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Woo
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Fairman
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D002908:Chronic Disease; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology