title: Endovascular treatment of thoracic aortic aneurysms with a short proximal landing zone using scalloped endografts.
abstract: BACKGROUND
  The suitability of the proximal landing zone remains one of the main limitations to thoracic endovascular aortic repair (TEVAR). The advent of custom-made scalloped stent grafts widens the endovascular options for patients with challenging anatomy. The objective of this study was to present our early and midterm results of custom-made scalloped thoracic stent grafts.
  
  
  METHODS
  Prospectively acquired data relating to patient demographics, procedure details, clinical outcome, and complications were analyzed. In addition, we analyzed preoperative and postoperative computed tomography scans to evaluate aneurysm morphology, graft placement, side-vessel patency, and endoleaks.
  
  
  RESULTS
  Twenty-one patients with a median age of 71 years (range, 35-81 years) underwent custom-made scalloped TEVAR, eight of whom had a concomitant hybrid repair. Procedural success was achieved in all cases. Proximal seal was achieved in all cases, with no type I endoleaks. There were no cases of retrograde dissection and no conversions to open repair. The median follow-up period was 36 weeks (range, 3-183 weeks). Two patients died in the hospital. Three patients suffered a stroke. Three patients had a type II endoleak, one of whom had significant sac enlargement requiring reintervention. One patient had a type III endoleak requiring reintervention. There were no cases of graft migration.
  
  
  CONCLUSIONS
  Our midterm results show that custom-made scalloped TEVAR is an acceptable treatment of thoracic aortic aneurysms with a short proximal landing zone. Longer term outcome data are required to establish wider use of scalloped thoracic endografts.
authors.affiliation: Department of Interventional Radiology, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom. Electronic address: Ali.alsafi03@alumni.imperial.ac.uk.
authors.forename: Ali
authors.initials: A
authors.lastname: Alsafi
authors.affiliation: Imperial Vascular Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
authors.forename: Colin D
authors.initials: CD
authors.lastname: Bicknell
authors.affiliation: Imperial Vascular Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
authors.forename: Nung
authors.initials: N
authors.lastname: Rudarakanchana
authors.affiliation: Department of Interventional Radiology, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom.
authors.forename: Elika
authors.initials: E
authors.lastname: Kashef
authors.affiliation: Imperial Vascular Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Gibbs
authors.affiliation: Imperial Vascular Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Cheshire
authors.affiliation: Imperial Vascular Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Jenkins
authors.affiliation: Department of Interventional Radiology, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Hamady
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency