title: Clinical outcomes of thoracic endovascular aneurysm repair using commercially available fenestrated stent graft (Najuta endograft).
abstract: OBJECTIVE
  Thoracic endovascular aneurysm repair (TEVAR) for the aortic arch aneurysm is challenging because of its curved anatomic configuration and the presence of the supra-aortic branches. The Najuta fenestrated endograft (Kawasumi Laboratories, Inc, Tokyo, Japan) was developed to treat aortic arch diseases, offering maximal proximal landing length while preserving the blood flow to the supra-aortic branches. We evaluated the perioperative and midterm outcomes of this fenestrated endograft.
  
  
  METHODS
  Between July 2007 and July 2013, 32 patients were treated with the Najuta endograft at three vascular centers. The mean age of the patients was 74.5 ± 9.8 years (23 patients were men). Technical success, complication, overall survival rate, freedom from aneurysm-related death, secondary intervention, aneurysm enlargement, device migration, and patency of supra-aortic branches were investigated retrospectively.
  
  
  RESULTS
  The median follow-up period was 2.5 years (range, 0.2-6.2 years). Seventy-one supra-aortic vessels (30 brachiocephalic arteries, 31 left common carotid arteries, 10 left subclavian arteries) were planned to be preserved with fenestrations. Technical success rate was 91% (29 of 32; three type I endoleaks were seen), and five perioperative complications (two Stanford A dissections, one cerebral infarction, one celiac artery obstruction, one spinal cord ischemia) were recognized. Perioperative death was not observed. Overall survival rate and rate of freedom from aneurysm-related death at 3 years were 67% and 97%, respectively. The rate of freedom from secondary intervention and the rate of freedom from aneurysm enlargement at 3 years were 84% and 85%, respectively. Device migration was not observed. There were two branch (left carotid artery and left subclavian artery) occlusions at 2 weeks after TEVAR due to the endograft's infolding. No other branch occlusion was seen in this follow-up period. As a result, the patency rate of the supra-aortic branch was 97% at 3 years.
  
  
  CONCLUSIONS
  The perioperative and 3-year outcomes of TEVAR using the Najuta precurved, fenestrated endograft demonstrated high freedom from aneurysm enlargement and patency rates of the supra-aortic branches.
authors.affiliation: Department of Radiology, Nara Medical University, Nara, Japan. Electronic address: shinichi18548342@gmail.com.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Iwakoshi
authors.affiliation: Department of Radiology, Nara Medical University, Nara, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Ichihashi
authors.affiliation: Department of Radiology, Nara Medical University, Nara, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Itoh
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Nara, Japan.
authors.forename: Nobuoki
authors.initials: N
authors.lastname: Tabayashi
authors.affiliation: Department of Radiology, Matsubara Tokusyukai Hospital, Matsubara, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Sakaguchi
authors.affiliation: Department of Cardiovascular Surgery, Matsubara Tokusyukai Hospital, Matsubara, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Department of Cardiovascular Surgery, Yao Tokusyukai Hospital, Yao, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakao
authors.affiliation: Department of Radiology, Nara Medical University, Nara, Japan.
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Kichikawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002544:Cerebral Infarction / Q000453:epidemiology; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D016896:Treatment Outcome; D014654:Vascular Patency