The Proximal Landing Zone in Endovascular Repair of the Thoracic Aorta

Examination of factors in type I endoleak development after thoracic endovascular repair

“…Because of hemodynamic considerations for some authors and anatomic ones for others, the position of endograft deployment has been advocated as an important criterion to consider in correlation with neck length. 24,25 Indeed, a relationship between the endograft landing position and the drag forces acting on the endograft has been proved by Cheng et al 26 The force is greatest at the top of the arch and decreases significantly in the descending aorta. These findings have led some authors to modify their criteria of proximal aortic neck length in case of zone 1 endografting to 30 mm or more.…”

“…These findings have led some authors to modify their criteria of proximal aortic neck length in case of zone 1 endografting to 30 mm or more. 24,25 Furthermore, numerous studies 5,6,8,21 report landing zone 2 as anatomically unsuitable for stent graft implantation because it can favor endoleak. These authors argue, first, that LSA overstenting exposes the stent graft to abrupt angulation with, in consequence, excessive mechanical stress acting on the stent and incomplete apposition of the devices, thus incurring a risk of type I endoleak.…”

The French National Authority for Health reports on thoracic stent grafts

“…2,6,9,14,18,20,21,29,34 No endoleaks occurred in two studies of TAAs 6,18 and two studies of TADs. 2,31 The mean rate of endoleaks was highly similar for TAAs at 10.3% (range, 4%-30%) and TADs at 11.1% (range, 7%-47%). With a total of 32 procedures, the total rate of endoleaks for TAD was 6.25%.…”

“…The type of endoleak was specified in eight of 18 studies. 9,15,18,23,[26][27][28]31 In patients with an endoleak (13.4% of 371 patients), 76% of the endoleaks were type 1 leaks (remaining endoleaks at the end of the procedure), 20% were type 2, and 4% were type 3. No early type 4 endoleaks were observed.…”

Intentional coverage of the left subclavian artery during endovascular stent graft repair for thoracic aortic disease

“…However, both technical and long-term success depend on anatomical conditions for optimal fixation of the SG. For this reason, complete coverage of the LSA ostium has to be used at times to expand the application of endovascular devices to aortic pathologies adjacent to the LSA [5,8,15,16]. Approximately 30% of our patients required complete coverage of the LSA, which did not cause severe problems during a mean 19-month follow-up period.…”