title: Treatment of aortic arch aneurysms with a modular transfemoral multibranched stent-graft: initial experience.
abstract: OBJECTIVE
  To present an initial experience with a new modular transfemoral multibranched stent-graft for treating aortic arch aneurysms.
  
  
  METHODS
  Six patients, considered high risk for open surgery, were treated with a custom-made branched stent-graft. Two patients had aortic arch aneurysms, three had descending thoracic aortic aneurysms involving the distal arch, and one had a saccular aneurysm of the arch adjacent to the origin of the innominate artery. All patients had undergone a staged left carotid subclavian bypass before the endovascular procedure. Each branched graft had a 12-mm side branch for the innominate artery and an 8-mm side branch for the left common carotid artery. The branches were extended into their respective target arteries with covered self-expanding stents.
  
  
  RESULTS
  Aneurysm exclusion without endoleak was successful in 5 of the 6 patients, and 11 of the 12 target vessels were successfully cannulated and preserved. Patient 1 developed a type I endoleak that was managed successfully with coiling and gluing of the aneurysm sac. Patients 2, 3, 5, and 6 had uneventful placement of the prostheses, with successful exclusion of the aneurysm sac. In patient 4, cannulation of the innominate branch was unsuccessful, and an extra-anatomic bypass was necessary to perfuse the right carotid and vertebral arteries.
  
  
  CONCLUSIONS
  We have demonstrated the technical feasibility of a modular transfemoral branched stent-graft for treatment of aortic arch aneurysms. Our initial experience has shown that the method is relatively safe. Long-term follow-up is necessary to evaluate the efficacy and safety of this new device.
authors: Division of Vascular Surgery, Department of Surgery, McGill University, Jewish General Hospital, Montreal, Quebec, Canada. cherriezack@gmail.com
authors: Cherrie Z
authors: CZ
authors: Abraham
authors: Christos
authors: C
authors: Lioupis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D057867:Endoleak / Q000209:etiology / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome