AZUMA Takashi
   Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Assistant Professor
Language English
Title Initial Experience of a Precurved Fenestrated/branched Convertible Endograft for Aortic Arch Lesions
Conference 2019 Vascular Annual Meeting
Promoters The Society for Vascular Surgery
Conference Type International society and overseas society
Presentation Type Speech
Lecture Type General
Publisher and common publisher◎YOKOI Yoshihiko, AZUMA Takashi, NIINAMI Hiroshi
Date 2019/06/12
Venue
(city and name of the country)
Washington, D.C. USA
Society abstract Journal of Vascular Surgery 69(6),e49-e50 2019
Summary Objectives
To evaluate the early Results of an entirely endovascular treatment using a precurved fenestrated/branched convertible endograft for thoracic aortic aneurysms and aortic dissection extended to the aortic arch.

Methods
From September 2017 to December 2018, 105 patients who required stent graft landing in the aortic arch were treated with precurved fenestrated/branched convertible endograft at 20 Japanese centers. The device has six three-dimensional curved stent skeleton types similar to aortic arch configurations and two to four individual graft fenestrations that are composed of a nitinol ring and hydrogel coils for the availability of additional branch endograft implantations (Fig 1). The endografts were fabricated based on preoperative three-dimensional computed tomographic images. Fenestration sizes were set within each supra-aortic branch diameter (ranged, 7-12 mm) and the branch endografts were implanted as necessary

Results
Technical and initial success were achieved in 104 and 98 cases, respectively. All of the device's proximal end was at zones 0. The lesions' proximal end ranged from zones 0 to 3 in 9, 32, 58, and 6 patients, and the number of branch endograft implantations was 0 to 4 were 18, 54, 17, 15, and 1, respectively. No branch occlusion or proximal migration of the device occurred and two patients died owing to cerebrovascular complication and access route bleeding.

Conclusions
A precurved fenestrated/branched convertible endograft for endovascular repair in aortic arch disease minimizes operative complication risks and the physical burden for patients. Although most patients had an inadequate proximal landing zone, low mortality and morbidity and satisfactory clinical success were achieved in early outcomes, suggesting that this entirely endovascular treatment may be effective for aortic arch disease.