Endovascular repair for distal arch aneurysms

: In the European and north American countries, stent grafts (SG) for endovascular repair of thoracic aortic aneurysms (TAA) have been commercially available for several years, whereas, in Japan, a manufactured SG had not been approved for this application until March 2008. Nevertheless, endovascular thoracic intervention began to be performed in Japan in the early 1990s, with homemade devices in most cases. Many researchers have continued to develop their homemade devices. We have participated in joint design and assessment efforts with a SG manufacturer, focusing primarily on fenestrated SG used in repairs at the distal arch, a site especially prone to aneurysm. For 15 years since 1995, over 1,120 patients of TAA have been treated with the endovascular technique using the SG in our hospital. The SG which was composed of several units of self-expanding Z stents covered with a polyester fabric or ePTFE, was individually designed for each patient. For distal arch aneurysms, SG should be so designed that it has scallop or fenestration on the graft to keep the blood flow into arch vessels. Exclusion of the aneurysms or closure of their entries without endoleak was achieved within 2 weeks postoperatively in over 96% of the cases. Endovascular stent grafting has the potential as a safe and useful treatment for thoracic aortic aneurysms, but further assessment is necessary of its efficacy over a longer postoperative period.