title: Application of unibody single-branch endografts in Stanford type B dissections with primary entry tear adjacent to the left subclavian artery: a computed tomography-based planning study.
abstract: BACKGROUND
  A custom-made unibody single-branch endograft (USBE) could provide great gains in the landing zone, while maintaining a left subclavian artery (LSA) perfusion in some patients with Stanford type B dissections (TBADs). We performed a computed tomography (CT)-based planning study to determine the proportion of TBAD patients who could benefit from this custom-made USBE and ascertained the possibility of an off-the-shelf USBE in an emergency setting.
  
  
  METHODS
  We carried out a retrospective study of TBAD patients with optimal CT scans at our center from 2007 to 2013. Patients' CT scans were analyzed using 3-dimensional reconstruction software. After generating a centerline of flow, measurements (including numerous morphologic characteristics of anatomy) were evaluated. A selected subset of patients suitable for USBE was determined. Finally, the most frequently used configurations of endografts were figured out by subgroup analysis.
  
  
  RESULTS
  A total of 314 patients with optimal digital imaging communications in medicine (DICOM) data were included in our study. The main primary entry tears (MPETs) were located at 22.8 ± 17.3 and 36.3 ± 18.6 mm distal to the LSA and the left common carotid artery, respectively. Overall, 169 (54.2%) patients with MPET distal to LSA (＞20 mm) could be treated by tubular stent grafts. Of the 143 patients who had intimal tears adjacent to the LSA (≤20 mm), there were 111 (35.4%) patients who could benefit from treatment using USBE based on our selection criteria. Subgroup analysis estimated the number of graft configurations needed to treat a proportion of patients: 1 design would treat 6.7% of the population, 5 designs would treat 23.1%, 10 designs would treat 37.6%, and 20 configurations would treat 54.8% .
  
  
  CONCLUSIONS
  In all, 35.4% patients with TBAD could potentially benefit from USBE. The use of off-the-shelf endografts might be possible in cases of emergency, given the evidence of recurrent configurations.
authors.affiliation: Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People's Republic of China.
authors.forename: Chen
authors.initials: C
authors.lastname: Huang
authors.affiliation: Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People's Republic of China.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People's Republic of China.
authors.forename: Dian
authors.initials: D
authors.lastname: Huang
authors.affiliation: Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People's Republic of China.
authors.forename: Tong
authors.initials: T
authors.lastname: Qiao
authors.affiliation: Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People's Republic of China. Electronic address: zhouminnju@gmail.com.
authors.forename: Min
authors.initials: M
authors.lastname: Zhou
authors.affiliation: Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, People's Republic of China. Electronic address: huangchen132@sina.com.
authors.forename: Changjian
authors.initials: C
authors.lastname: Liu
mesh_terms: D000784:Aortic Dissection / 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 / Q000295:instrumentation*; D002681:China; D057510:Endovascular Procedures / Q000295:instrumentation*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed