Proximal Scallop in Thoracic Endovascular Aortic Aneurysm Repair to Overcome Neck Issues in the Arch.
OBJECTIVE
To evaluate initial experience with a custom made proximal scalloped stent graft for thoracic endovascular aortic repair (TEVAR) of aortic aneurysms involving the arch.


METHODS
Between September 2012 and November 2014, patients presenting with a thoracic aortic aneurysm (TAA) with short or angulated neck were selected for treatment by custom made proximal scalloped Relay Plus stent grafts (ABS Bolton Medical, Barcelona, Spain). Prospectively acquired data relating to patient demographics, procedure details, clinical outcomes, and complications were analyzed retrospectively.


RESULTS
Ten selected patients (50% male, mean age 77 ± 8 years) were treated using a thoracic custom made Relay Plus stent graft, three of whom underwent additional cervical supra-aortic trunk revascularizations. TAA were fusiform in four cases, saccular in three, and three patients were treated for proximal type I endoleaks after previous standard TEVAR. The graft was landed in zone 2 in 3 cases, in zone 1 in 4 cases, and in zone 0 in 3 cases. The custom made scallop was designed to preserve flow in the left subclavian artery in three patients, in the left common carotid artery in four, and in the innominate artery in three. No proximal type I endoleak occurred and proximal sealing was achieved in all cases, with a technical success rate of 100%. All targeted vessels were patent. During a mean follow up of 12 ± 5 months, no conversion to open surgical repair and no aortic rupture occurred. One patient died post-operatively from myocardial infarction and one patient suffered a stroke with complete recovery. One patient had a distal type I endoleak on the 6 month CT scan and is scheduled for distal extension. No paraplegia, retrograde dissection and no other aortic related complications were recorded.


CONCLUSIONS
Proximal scalloped stent grafts appear to be an effective additional tool for TEVAR of TAA when dealing with short or angulated proximal necks.
Service de Chirurgie Cardiaque et Vasculaire - Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
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Ben Abdallah
Service de Chirurgie Cardiaque et Vasculaire - Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Université Paris-Descartes, Faculté de Médecine, Paris, France.
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El Batti
Service de Radiologie Interventionnelle - Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Université Paris-Descartes, Faculté de Médecine, Paris, France.
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Sapoval
Service de Chirurgie Cardiaque et Vasculaire - Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Université Paris-Descartes, Faculté de Médecine, Paris, France.
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Abou Rjeili
Service de Chirurgie Cardiaque et Vasculaire - Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Université Paris-Descartes, Faculté de Médecine, Paris, France.
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Fabiani
Service de Chirurgie Cardiaque et Vasculaire - Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Université Paris-Descartes, Faculté de Médecine, Paris, France.
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Julia
Service de Chirurgie Cardiaque et Vasculaire - Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Université Paris-Descartes, Faculté de Médecine, Paris, France. Electronic address: jean-marc.alsac@egp.aphp.fr.
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Alsac
D000368:Aged; D000369:Aged, 80 and over; D059925:Anatomic Landmarks; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009333:Neck; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed
Aneurysm; Aortic; Arch; Endovascular repair