Advantage of a precurved fenestrated endograft for aortic arch disease: Simplified arch aneurysm treatment in Japan 2010 and 2011

Objective: We evaluated the results of our previous study investigating a precurved fenestrated endograft treatment for thoracic aortic aneurysms and aortic dissection extended to the aortic arch. Methods: From February 2010 to December 2011 at 35 Japanese centers, 383 patients (mean age, 75.7 +/- 9.4 years) who required stent-graft landing in the aortic arch were treated with a precurved fenestrated endograft. The device has 19 3-dimensional curved stent skeleton types similar to aortic arch configurations and 8 graft fenestration types and is 24 to 44 mm in diameter and 16 to 20 cm long. The endografts were fabricated according to preoperative 3-dimensional computed tomographic images. Results: Technical and initial successes were achieved in 380 and 364 cases, respectively. Device proximal end was at zones 0 to 2 in 363, 15, and 2 patients, respectively. Lesions' proximal end ranged from zone 0 to 3 in 16, 125, 195, and 44 patients, respectively. The mean operative and fluoroscopic times were 161 +/- 76 and 26 +/- 13 min, respectively. The complications included stroke (7 patients), permanent paralysis (3), and perioperative death (6). No branch occlusion or proximal migration of the device occurred during follow-up. Conclusions: A precurved fenestrated endograft for endovascular repair in aortic arch disease rendered catheter manipulation simple and minimized operative complication risks. Although most patients had inadequate proximal landing zone and severely angled complex configuration, low mortality and morbidity and satisfactory clinical success were early outcomes, suggesting that this simplified treatment may be effective for aortic arch disease. (J Thorac Cardiovasc Surg 2013;145:S103-9)