• Feng Chen, Wei Guo, Yuxiang Song, Guoyi Sun, Jiang Xiong, Xin Jia, Xiaoping Liu, Xiaohui Ma, and Hongpeng Zhang.
• Department of Vascular and Endovascular Surgery, General Hospital of Chinese PLA, Beijing, 100853, P. R. China.
• Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 May 8; 30 (5): 599-603.

ObjectiveTo explore the effectiveness of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) with hostile stent-graft proximal landing zone.MethodsA retrospective analysis was made on the clinical data of 13 patients with BTAI with hostile stent-graft proximal landing zone treated by TEVAR between December 2007 and December 2014. There were 10 males and 3 females with the mean age of 44 years (range, 24-64 years). The imaging examination indicated Stanford type B aortic dissection in 7 cases, pseudoaneurysm in 3 cases, aneurysm in 1 case, and penetrating ulcer in 2 cases. According to the partition method of thoracic aortic lesion by Mitchell, 8 cases underwent stent-graft with left subclavian artery (LSA) coverage, 3 underwent chimney stents for LSA, and 2 for left common carotid artery (LCCA). In 2 cases receiving chimney TEVAR involving LCCA, one underwent steel coils at the proximal segment of LSA to avoid type II endoleak and the other underwent in situ fenestration for endovascular reconstruction of LSA.ResultsAll TEVAR procedures were successfully performed. The mean operation time was 1.8 hours (range, 1-3 hours); the mean intraoperative blood loss was 120 mL (range, 30-200 mL); and the mean hospitalization time was 15 days (range, 7-37 days). No perioperative death and paraplegia occurred. The patients were followed up 3-30 months (mean, 18 months). Type I endoleak occurred in 1 case during operation and spontaneously healed within 6 months. Hematoma at brachial puncture site with median nerve compression symptoms occurred in 1 case at 3 weeks after operation; ultrasound examination showed brachial artery pseudoaneurysm and thrombosis, and satisfactory recovery was obtained after pseudoaneurysmectomy. No obvious chest pain, shortness of breath, left upper limbs weakness, numbness, and dizziness symptoms were observed. Imaging examination revealed that stentgraft and branched stent remained in stable condition. Meanwhile the blood flow was unobstructed. No lesions expanded and ruptured. No new death, bacterial infection, or other serious complications occurred.ConclusionsAccording to Mitchell method, individualized plan may be the key to a promising result. More patients and further follow-up need to be included, studied, and observed.

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