title: Midterm results of endovascular stent grafts in the proximal aortic arch (zone 0): an imaging perspective.
abstract: BACKGROUND
  Endovascular options to repair the arch and ascending aorta are rapidly evolving. Little is known about the durability of endovascular devices deployed at this location. This report describes a single-centre experience with the novel application of thoracic endovascular aortic repair (TEVAR) by examining clinical and radiological outcomes.
  
  
  METHODS
  A retrospective review was performed for a cohort of patients undergoing TEVAR of the arch or ascending aorta, or both, at a single centre from November 2008-July 2012.
  
  
  RESULTS
  Sixteen patients were included in the study, with mean imaging follow-up of 38 months (range, 15-72 months). Two complications at the proximal landing zone in the ascending aorta were identified: 1 endoleak and 1 infolding identified at 3 and 24 months postoperatively, respectively. Clinically, both these complications were attributed to the bird-beak configuration at the proximal landing zone site. At up to 72 months of follow-up, there were no cases of retrograde dissection of the native sinus of Valsalva. There were no cases of stent graft migration, graft fracture, open surgical reintervention for aortic pathologic conditions, or late mortality.
  
  
  CONCLUSIONS
  Early outcomes suggest that the current generation of thoracic aortic endografts can be placed in the complex anatomy of the ascending aorta and aortic arch without a high incidence of early graft fracture or migration. Future endeavors will need to focus on techniques to achieve optimal apposition with the curves of the ascending aorta. These findings are important as indications for endovascular aortic therapies expand to address proximal aortic pathologic conditions.
authors.affiliation: Division of Cardiac Surgery, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada. Electronic address: jehangir.appoo@albertahealthservices.ca.
authors.forename: Jehangir J
authors.initials: JJ
authors.lastname: Appoo
authors.affiliation: Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Herget
authors.affiliation: Division of Cardiac Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Zlatko I
authors.initials: ZI
authors.lastname: Pozeg
authors.affiliation: Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Mollie C
authors.initials: MC
authors.lastname: Ferris
authors.affiliation: Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Wong
authors.affiliation: Department of Anaesthesia, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Gregory
authors.affiliation: Division of Cardiac Surgery, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Arjun K
authors.initials: AK
authors.lastname: Gupta
authors.affiliation: Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Naeem
authors.initials: N
authors.lastname: Merchant
authors.affiliation: Division of Cardiac Surgery, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: William D T
authors.initials: WD
authors.lastname: Kent
mesh_terms: D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D061214:Patient Safety; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome