title: Endovascular repair by customized branched stent-graft: A promising treatment for chronic aortic dissection involving the arch branches.
abstract: OBJECTIVE
  There is no approved special endovascular device for use in preventing entry tears in the distal part of ascending aorta or in the aortic arch and preserving the arch branch arteries. Thus, we have designed a novel branched stent-graft, and herein report the initial clinical outcomes.
  
  
  METHODS
  Between August 2009 and January 2014, 51 patients with aortic dissections involving the aortic arch were treated by endovascular branched stent-grafts. There were 7 Stanford type A aortic dissections, 22 retrograde type A aortic dissections, and 22 Stanford type B aortic dissections (including 4 localized aortic arch dissections). All patients were treated while in the chronic phase (>2 weeks).
  
  
  RESULTS
  All of the proximal entry tears in the arch were successfully excluded, and all of the treated branch arteries remained patent. No new cerebral infarction occurred. There was 1 death from a retrograde type A dissection, occurring 6 days after the endovascular procedure. The median follow-up period was 44 months (range, 14-66 months). No additional complications or mortality occurred. Complete thrombosis in the false lumen of the aortic arch was formed in all patients, and significant true lumen recovery and false lumen shrinkage were demonstrated in different levels of the thoracic aorta according to computed tomography angiography at 1 year postsurgery (P < .001).
  
  
  CONCLUSIONS
  In patients with aortic dissection involving the arch branches, the customized branched stent-graft may provide a feasible endovascular treatment option. A larger series of cases with longer follow-up is needed to substantiate these results.
authors.affiliation: Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Qingsheng
authors.initials: Q
authors.lastname: Lu
authors.affiliation: Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Jiaxuan
authors.initials: J
authors.lastname: Feng
authors.affiliation: Department of Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Zhiqing
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Radiology, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Zhongzhao
authors.initials: Z
authors.lastname: Teng
authors.affiliation: Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: xueguanky@163.com.
authors.forename: Zaiping
authors.initials: Z
authors.lastname: Jing
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: aortic arch; aortic dissection; endovascular repair; stent graft