title: A geometric reappraisal of proximal landing zones for thoracic endovascular aortic repair according to aortic arch types.
abstract: This study assessed whether the additional use of the aortic arch classification in type I, II, and III may complement Ishimaru's aortic arch map and provide valuable information on the geometry and suitability of proximal landing zones for thoracic endovascular aortic repair.
  
  
  
  Anonymized thoracic computed tomography scans of healthy aortas were reviewed and stratified according to the aortic arch classification, and 20 of each type of arch were selected. Further processing allowed calculation of angulation and tortuosity of each proximal landing zone. Data were described indicating both proximal landing zone and type of arch (eg, 0/I).
  
  
  
  Angulation was severe (>60°) in 2/III and in 3/III. Comparisons among the types of arch showed an increase in proximal landing zones angulation (P < .001) and tortuosity (P = .009) depending on the type of arch. Comparisons within type of arch showed no change in angulation and tortuosity across proximal landing zones within type I arch (P = .349 and P = .409), and increases in angulation and tortuosity toward more distal proximal landing zones within type II (P = .003 and P = .043) and type III (P < .001 in both).
  
  
  
  The aortic arch classification is associated with a consistent geometric pattern of the aortic arch map, which identifies specific proximal landing zones with suboptimal angulation for stent graft deployment. Arches II and III also appear to have progressively less favorable anatomy for thoracic endovascular aortic repair compared with arch I.
authors.affiliation: Division of Vascular Surgery II, Istituto di Ricovero e Cura a Carattere Scientifico-Policlinico San Donato, San Donato Milanese, Italy; Thoracic Aortic Research Center, Istituto di Ricovero e Cura a Carattere Scientifico-Policlinico San Donato, San Donato Milanese, Italy. Electronic address: massimiliano.marroccotrischitta@grupposandonato.it.
authors.forename: Massimiliano M
authors.initials: MM
authors.lastname: Marrocco-Trischitta
authors.affiliation: Thoracic Aortic Research Center, Istituto di Ricovero e Cura a Carattere Scientifico-Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Hector W
authors.initials: HW
authors.lastname: de Beaufort
authors.affiliation: Division of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico-Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Secchi
authors.affiliation: Thoracic Aortic Research Center, Istituto di Ricovero e Cura a Carattere Scientifico-Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Theodorus M
authors.initials: TM
authors.lastname: van Bakel
authors.affiliation: Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico-Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ranucci
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Joost A
authors.initials: JA
authors.lastname: van Herwaarden
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
authors.affiliation: Division of Vascular Surgery II, Istituto di Ricovero e Cura a Carattere Scientifico-Policlinico San Donato, San Donato Milanese, Italy; Thoracic Aortic Research Center, Istituto di Ricovero e Cura a Carattere Scientifico-Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
mesh_terms: D000368:Aged; D059925:Anatomic Landmarks; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000601:surgery; D001027:Aortography / Q000379:methods*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies