title: Complications at the Proximal Landing Zone of Endovascular Stent Grafts Deployed in Surgically Replaced Ascending Aorta.
abstract: BACKGROUND
  The ascending aorta, with its hostile angulations and forces, is the next frontier in the evolution of endovascular surgery. Type II hybrid arch repair, involving surgical replacement of the ascending aorta, arch debranching, and stent graft deployment in the ascending aortic graft, offers an opportunity to study the behavior of an endovascular prosthesis in the ascending aorta. We report complications seen at the proximal landing zone after type II hybrid arch repair.
  
  
  METHODS
  A dedicated imaging protocol was used to monitor 20 consecutive patients who underwent type II hybrid arch repair at a single center from June 2009 to July 2014.
  
  
  RESULTS
  Mean age was 66 years (range, 47 to 82 years). Mean imaging follow-up was 34 months (range, 12 to 64 months). There was 1 operative death (5%). Bird beaking (>5 mm of nonapposition) of the stent graft at the proximal landing zone occurred in 12 patients, and >20 mm of bird beaking occurred in 7 patients. Proximal landing zone complications occurred in 4 patients (20%), comprising 2 type Ia endoleaks, 1 graft migration, and 1 graft infolding detected on postoperative days 4, 11, 5, and 755, respectively. Three patients underwent endovascular reintervention for proximal landing zone complications. There were no late deaths.
  
  
  CONCLUSIONS
  Thoracic aortic stent grafts may be prone to proximal landing zone complications when deployed in the ascending aorta. Bird beaking is common when endografts are deployed in the Dacron (DuPont, Wilmington, DE) ascending aorta. Angulation issues will likely need to be overcome by stent graft refinement to enable future closed chest approaches to the ascending aorta.
authors.affiliation: Division of Interventional Radiology, Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada; Calgary Thoracic Aortic Program, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Vamshi K
authors.initials: VK
authors.lastname: Kotha
authors.affiliation: Division of Interventional Radiology, Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada; Calgary Thoracic Aortic Program, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Herget
authors.affiliation: Calgary Thoracic Aortic Program, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Division of Cardiac Surgery, Department of Cardiac Sciences and Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada. Electronic address: jehangir.appoo@albertahealthservices.ca.
authors.forename: Jehangir J
authors.initials: JJ
authors.lastname: Appoo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D057867:Endoleak / Q000453:epidemiology / Q000209:etiology*; D057510:Endovascular Procedures / Q000009:adverse effects; D004868:Equipment Failure; D005260:Female; D005548:Foreign-Body Migration / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011093:Polyethylene Terephthalates; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology
chemical_list: D011093:Polyethylene Terephthalates