Outcome comparison of thoracic endovascular aortic repair performed outside versus inside proximal landing zone length recommendation.

Abstract Objectives Success of thoracic endovascular aortic repair (TEVAR) relies heavily on the proximal landing zone (PLZ) sealing. Most Instructions for Use of thoracic endografts recommend a PLZ length of at least 2cm. Because of the complex aortic anatomic features, TEVAR landing in zone 1 to zone 3 may not meet this requirement. The aim of this study was to examine the impact of 2-cm PLZ non-adherence was related to adverse outcomes after TEVAR. Methods A retrospective review was performed on patients who underwent zone 1, 2, and 3 landing TEVAR at a single institution between November 2013 and October 2018. Pre- and post-operative computed tomography angiography images were analyzed using 3-dimensional reconstruction. The patients were categorized into 2 groups: PLZ ≥2-cm group (adherence group) and PLZ Results The cohort comprised 63 patients (18 adherence group, 45 non-adherence group) with a mean age of 53.3±20.6 years. Indications for TEVAR were blunt traumatic injury (65.1%), thoracic aneurysm (23.8%), penetrating ulcer (9.5%), and type B dissection (1.6%). Mean PLZ length was significantly shorter for the non-adherence group (8±7 mm for the non-adherence group vs 34±15 mm for the adherence group, p Conclusions Achieving recommended sealing zone of 2-cm centerline length is paramount to avoiding device-related adverse outcomes. We recommend careful surveillance in patients undergoing urgent TEVAR with less than a 2-cm proximal landing zone.