Results From a Nationwide Registry on Scalloped Thoracic Stent-Grafts for Short Landing Zones.
To report the perioperative results and short-term follow-up of patients treated with scalloped thoracic stent-grafts.



A multicenter registry in the Netherlands captured data on 30 patients (mean age 68 years; 17 men) with thoracic aortic pathology and a short (<20 mm) proximal or distal landing zone who received a custom-made scalloped stent-graft between January 2013 and February 2016. Patients were treated for saccular (n=13) aneurysms, fusiform (n=9) aneurysms, pseudoaneurysms (n=4), or chronic type B dissections (n=4). The scallop was used to preserve flow in the left subclavian artery (LSA) (n=17), left common carotid artery (n=5), innominate artery (n=1), and celiac trunk (n=7). In 7 (23%) patients, the scallop also included the adjacent artery.



Technical success was achieved in 28 (93%) patients. In 1 patient, a minor type Ia endoleak was observed intraoperatively, which was no longer visible on computed tomography angiography at 3 months. In another patient, the LSA was unintentionally obstructed due to migration of the stent-graft on deployment. Concomitant carotid-carotid or carotid-subclavian bypass was performed in 4 patients. There was no retrograde type A dissection or conversion to open surgery. In-hospital mortality was 3%, and the perioperative ischemic stroke rate was 3%. At a mean follow-up of 9.7 months (range <1 to 31), 29 of 30 target vessels were patent.



The scalloped stent-graft appears to be a safe and relatively simple alternative for the treatment of thoracic aortic lesions with short landing zones. Larger patient series and long-term follow-up are required to confirm these early results.
1 Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands.
Emma
E
van der Weijde
1 Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands.|2 Department of Vascular & Endovascular Surgery, University Medical Centre Utrecht, the Netherlands.
Olaf J
OJ
Bakker
3 Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, the Netherlands.
Ignace F J
IF
Tielliu
3 Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, the Netherlands.
Clark J
CJ
Zeebregts
1 Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands.
Robin H
RH
Heijmen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002908:Chronic Disease; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011183:Postoperative Complications / Q000401:mortality; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
aneurysm; aortic arch; endoleak; landing zone; pseudoaneurysm; scallop; stent-graft; thoracic aortic pathology; thoracic endovascular aortic repair; type B dissection