title: Total endovascular repair of thoracoabdominal aortic aneurysms with non-customized stent grafts.
abstract: BACKGROUND
  Total endovascular repair of thoracoabdominal aortic aneurysms with customized branched or fenestrated endografts could be technically challenging outside large-volume centers. This study aims to describe a new endovascular strategy for use of both noncustomized stent grafts and flow-diverting stents in treating complicated thoracoabdominal aortic aneurysms.
  
  
  METHODS
  Patients diagnosed with thoracoabdominal aortic aneurysms and deemed unfit for open surgical repair were recruited. The aim of the procedure was to cover the renovisceral segment of the aorta with flow-diverting uncovered stents, while covering the remaining aneurysm with stent grafts. Aneurysm morphologic evolution and the patency of the visceral branches were assessed at follow-up.
  
  
  RESULTS
  Between February 2012 and August 2013, 6 selective patients (4 men, mean age 58 years) underwent the novel joint procedure. During mean follow-up of 14 months, aneurysm shrinkage (maximum diameter decrease ＞5 mm) was demonstrated in 4 patients and aneurysm stabilization (maximum diameter decrease ＜5 mm) was observed in 2 patients. No aneurysm expansion was observed in any participants. Mean aneurysm diameter decreased from 65.0±8.8 mm to 58.5±12.2 mm (p=0.054), with a significant increase in average sac thrombus deposition volume (sac thrombosis ratio increased from 23.3%±7.4% to 98.0%±3.3%, p＜0.001). The majority of side branches (23 of 24) were successfully preserved.
  
  
  CONCLUSIONS
  Complete endovascular repair of thoracoabdominal aortic aneurysms with this novel joint procedure may be a feasible alternative in high surgical risk patients. Further validation of this technique is required to substantiate these results.
authors.affiliation: Division of Vascular Surgery, Changhai Hospital, Shanghai, China; Military Institute of Vascular Disease, the First Affiliated Hospital of the Second Military Medical University, Shanghai, China.
authors.forename: Yongxue
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Division of Vascular Surgery, Changhai Hospital, Shanghai, China. Electronic address: luqs@xueguan.net.
authors.forename: Qingsheng
authors.initials: Q
authors.lastname: Lu
authors.affiliation: Division of Vascular Surgery, Changhai Hospital, Shanghai, China.
authors.forename: Yifei
authors.initials: Y
authors.lastname: Pei
authors.affiliation: Division of Vascular Surgery, Changhai Hospital, Shanghai, China.
authors.forename: Mengtao
authors.initials: M
authors.lastname: Wu
authors.affiliation: Division of Vascular Surgery, Changhai Hospital, Shanghai, China.
authors.forename: Suming
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Division of Vascular Surgery, Changhai Hospital, Shanghai, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Hong
authors.affiliation: Military Institute of Vascular Disease, the First Affiliated Hospital of the Second Military Medical University, Shanghai, China.
authors.forename: Zaiping
authors.initials: Z
authors.lastname: Jing
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome