title: Long-term results of endovascular repair for distal arch and descending thoracic aortic aneurysms treated by custom-made endografts: usefulness of fenestrated endografts.
abstract: OBJECTIVE
  We evaluated early and long-term results of atherosclerotic aneurysm repair with custom-made endografts.
  
  
  METHODS
  Eighty-one consecutive patients underwent thoracic endovascular aortic repair with custom-made endografts. Fenestrated grafts were used in 37 patients (45.7%) to maintain blood flow of the neck and a landing zone for as long as possible for distal arch or proximal descending aneurysms. The rates of perioperative mortality, stroke, paraplegia, and primary endoleaks were assessed to evaluate in-hospital safety. The rates of endoleak development, survival, and freedom from aortic-related death were assessed to evaluate long-term efficiency.
  
  
  RESULTS
  Twenty-four patients (29.6%) underwent urgent operations, and 38 (46.9%) underwent distal arch or proximal descending aortic aneurysm repair. There was one case (1.2%) of in-hospital mortality and no cases of stroke. Permanent spinal injury occurred in one patient (1.2%). Early and late endoleaks occurred in one and 16 patients, respectively. The actuarial survival rates were 88.9%, 64.9%, and 51.7% at 1, 5, and 10 years, respectively. The actuarial rates of freedom from endoleaks were 90.1%, 81.3%, and 68.6% at 1, 5, and 10 years, respectively.
  
  
  CONCLUSIONS
  Early results of custom-made endografts were excellent, and fenestrated endografts were safe for distal arch and proximal descending aortic aneurysms.
authors.affiliation: Department of Cardiovascular, Thoracic and General Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Matsuyama
authors.affiliation: Department of Cardiovascular, Thoracic and General Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan.
authors.forename: Kunihide
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Cardiovascular, Thoracic and General Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nagahama
authors.affiliation: Department of Cardiovascular Surgery, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Miyazaki, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Nina
authors.affiliation: Department of Cardiovascular, Thoracic and General Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan.
authors.forename: Jouji
authors.initials: J
authors.lastname: Endou
authors.affiliation: Department of Cardiovascular Surgery, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Miyazaki, Japan.
authors.forename: Kazushi
authors.initials: K
authors.lastname: Kojima
authors.affiliation: Department of Cardiovascular, Thoracic and General Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Nishimura
authors.affiliation: Department of Cardiovascular, Thoracic and General Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Ishii
authors.affiliation: Department of Cardiovascular Surgery, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Miyazaki, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Yokota
keywords: custom-made; distal arch aneurysm; fenestrated endograft; long-term results; thoracic aortic aneurysm