title: Endograft repair for pseudoaneurysms and penetrating ulcers of the ascending aorta.
abstract: OBJECTIVE
  The aim of this paper is to report midterm results of thoracic endovascular aortic repair (TEVAR) for ascending aortic pseudoaneurysms (AAPs) and penetrating aortic ulcers (PAUs) of the ascending aorta.
  
  
  METHODS
  This study was retrospective and performed at tertiary centers. Eight patients with AAPs (n = 5) and PAUs (n = 3) received total endovascular repair of the ascending aorta. Patients with a history of type A aortic dissection or fusiform aneurysm were excluded. All patients analyzed were considered to be at high risk for open repair at the time of presentation.
  
  
  RESULTS
  Urgent intervention was performed in 6 (75%) cases. Primary clinical success was achieved in 7 (87.5%) cases. A low-flow type 3 endoleak remained asymptomatic and was managed conservatively. No TEVAR-related in-hospital mortality, primary conversion, cerebrovascular accidents, valve impairment, or myocardial infarction occurred. All patients were discharged home, alive and independent, after a median length of stay of 6 (range: 5-24) days. No patient was lost at a mean follow-up of 40 ± 33 (range: 4-93) months. Ongoing primary clinical success was maintained in all but 1 patient (type 3 endoleak): aortically related reintervention was never required. No endograft breakage or migration was observed. At 1-year follow-up, 7 (87.5%) aortic lesions had significant reduction in diameter (≥5 mm).
  
  
  CONCLUSIONS
  Ascending TEVAR was feasible, safe, and effective for AAPs and PAUs. In a very select subset of lesions, midterm results were favorable, with both standard and custom-designed endografts.
authors.affiliation: Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy. Electronic address: gabriele.piffaretti@uninsubria.it.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Piffaretti
authors.affiliation: Interventional Cardiology Department of Medicine, S. Anna Hospital, Como, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Galli
authors.affiliation: Vascular Surgery II and Thoracic Aortic Research Center, IRCCS Policlinico San Donato Teaching Hospital, University of Milan School of Medicine, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Lomazzi
authors.affiliation: Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Franchin
authors.affiliation: Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Castelli
authors.affiliation: Cardiac Surgery, Glenfield Hospital, University of Leicester, Leicester, United Kingdom.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
authors.affiliation: Vascular Surgery II and Thoracic Aortic Research Center, IRCCS Policlinico San Donato Teaching Hospital, University of Milan School of Medicine, Milan, Italy.
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
mesh_terms: D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D001027:Aortography; D001807:Blood Vessel Prosthesis; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D011474:Prosthesis Design; D012189:Retrospective Studies; D016896:Treatment Outcome; D014456:Ulcer / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006113:United Kingdom / Q000453:epidemiology
keywords: ascending aortic pseudoaneurysm; penetrating ulcer; thoracic endovascular aortic repair