title: Thoracic Endovascular Aortic Repair for Challenging Aortic Arch Diseases Using Fenestrated Stent Grafts From Zone 0.
abstract: BACKGROUND
  Although previous reports have described the repair of distal aortic arch aneurysms through debranching and chimney techniques, these methods invariably involve surgical management of the carotid artery. We report clinical results of thoracic endovascular aortic repair (TEVAR) using fenestrated stent grafts in the treatment of aortic arch aneurysms located less than 15 mm from the left common carotid artery.
  
  
  METHODS
  A semi-custom-made fenestrated stent graft designed to fit aortic arch tortuosity and preserve blood flow at least into the brachiocephalic and left common carotid arteries was placed from zone 0.
  
  
  RESULTS
  From 2007 through 2013, TEVAR from zone 0 was performed on 37 high-risk patients for open surgery (mean age 78.2 years). The mean length between the left common carotid artery and aortic aneurysm was 11.1 mm (range, 5 to 15 mm). The left subclavian artery was preserved for 26 patients (70.3%) through surgical reconstruction (n = 19) and graft fenestration (n = 7). The early mortality rate was 0%. Postoperative strokes and spinal cord ischemia occurred in 2 (5.4%) and 3 (8.1%) patients, respectively. Although type I endoleaks at discharge were noted in 12 (32.4%) patients, aneurysm enlargement was noted during follow-up in 6 (16.2%). Four patients (10.8%) underwent secondary interventions consisting of 3 coil embolization procedures; 2 re-TEVARs and 1 open conversion. There were no aorta-related late deaths. Survival and aorta-related event-free rates at 2 years were 86.3% and 88.8%, respectively.
  
  
  CONCLUSIONS
  Thoracic endovascular aortic repair using fenestrated stent graft from zone 0 can be considered as one of therapeutic options for high-risk patients with aortic arch diseases.
authors.affiliation: Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan. Electronic address: kurimoto-spr@umin.ac.jp.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kurimoto
authors.affiliation: Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
authors.forename: Ryushi
authors.initials: R
authors.lastname: Maruyama
authors.affiliation: Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
authors.forename: Kousuke
authors.initials: K
authors.lastname: Ujihira
authors.affiliation: Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
authors.forename: Naritomo
authors.initials: N
authors.lastname: Nishioka
authors.affiliation: Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
authors.forename: Kousei
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Iba
authors.affiliation: Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Hatta
authors.affiliation: Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Yamada
authors.affiliation: Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Nakanishi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D019616:Thoracic Surgical Procedures