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Michael D Dake - One of the best experts on this subject based on the ideXlab platform.
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Branch Vessel patency after thoracic endovascular aortic repair for type b aortic dissection
Annals of Vascular Surgery, 2020Co-Authors: Gregory A Magee, Anastasia Plotkin, Michael D Dake, Benjamin W Starnes, Sukgu M Han, Li Ding, Fred A WeaverAbstract:Background Thoracic endovascular aortic repair (TEVAR) for type B aortic dissections is used to promote false lumen (FL) thrombosis and favorable aortic remodeling, but its impact on occlusion of FL origin Branch Vessels has not been widely described. We compare FL versus true lumen (TL) Branch Vessel patency after TEVAR. Methods Patients treated by TEVAR for type B aortic dissection in zones 2–5 in the Vascular Quality Initiative from 2009 to 2018 were evaluated. The primary outcome was postoperative Branch patency. Secondary outcomes were need for Branch Vessel intervention, preoperative origin, and postoperative patency of individual Branch Vessels (celiac, superior mesenteric artery, renal arteries, and iliac arteries). A subset analysis was performed comparing acute and chronic dissections. Results Of 11,774 patients, 1,484 met criteria for analysis. The left renal was the most common to have FL origin (21.6%), whereas right and left common iliac arteries were the most likely to originate off both lumens (BLs; 22% and 24%). Branch Vessels that originated from the TL, FL, BLs, or were obstructed had postoperative patency rates of 99%, 99%, 99%, and 87% (P Conclusions Branch Vessel patency rates after TEVAR for a type B aortic dissection are high and are not significantly different for FL or BL origin Vessels compared with TL Vessels. Branches that are patent before TEVAR almost always remain patent after TEVAR, but Branch Vessel stenting may be required in less than 5%.
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changes in geometry and cardiac deformation of the thoracic aorta after thoracic endovascular aortic repair
Annals of Vascular Surgery, 2018Co-Authors: Kelsey Hirotsu, Michael D Dake, Gayoung Suh, Jason T Lee, Dominik Fleischmann, Christopher P ChengAbstract:Background Thoracic endovascular aortic repair (TEVAR) has dramatically expanded treatment options for patients with thoracic aortic pathology. The interaction between endografts and the dynamic anatomy of the thoracic aorta is not well characterized for repetitive physiologic stressors and subsequent issues related to long-term durability. Through three-dimensional (3D) modeling we sought to quantify cardiac-induced aortic deformation before and after TEVAR to assess the impact of endografts on dynamic aortic anatomy. Methods Eight patients with acute (n = 4) or chronic (n = 3) type B dissections, or chronic arch aneurysm (n = 1), underwent TEVAR with a single (n = 5) or multiple (n = 3) Gore C-TAG(s). Cardiac-resolved thoracic CT images were acquired pre- and post-TEVAR. 3D models of thoracic aorta and Branch Vessels were constructed in systole and diastole. Axial length, mean, and peak curvature of the ascending aorta, arch, and stented lumens were computed from the aortic lumen centerline, delineated with Branch Vessel landmarks. Cardiac-induced deformation was computed from mid-diastole to end-systole. Results Pre-TEVAR, there were no significant cardiac-induced changes for aortic axial length or mean curvature. Post-TEVAR, the ascending aorta increased in axial length (2.7 ± 3.1%, P Conclusions TEVAR for a range of indications not only causes direct geometric changes to the stented aorta but also results in dynamic changes to the ascending and stented aorta. In our cohort, endograft placement straightens the stented aorta and mutes cardiac-induced bending due to longitudinal stiffness. This is compensated by greater length and curvature changes from diastole to systole in the ascending aorta, relative to pre-TEVAR.
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Branched endovascular therapy of the distal aortic arch preliminary results of the feasibility multicenter trial of the gore thoracic Branch endoprosthesis
The Annals of Thoracic Surgery, 2016Co-Authors: Himanshu J Patel, David M Williams, Michael D Dake, Joseph E Bavaria, Michael J Singh, Mark Filinger, Michael P Fischbein, Jon S Matsumura, Gustavo S OderichAbstract:Background Endovascular treatment for aortic arch aneurysms often requires adjunctive use of hybrid deBranching procedures to maintain Branch Vessel perfusion. This study describes early results with a novel Branched arch endograft for total endovascular repair of distal arch aneurysms. Methods This US feasibility multicenter clinical trial evaluated 22 patients (mean age, 74.1 ± 10.5 years; 54.5% male) undergoing Branched thoracic endovascular aortic repair in Ishimaru zone 2. This endograft was designed with a single side Branch designed to facilitate aortic coverage proximal to the left subclavian artery while maintaining Branch Vessel patency. The pathologic features treated included fusiform (n = 10) and saccular (n = 12) aneurysms, with a mean aortic diameter of 5.7 ± 1.1 cm. The mean preoperative left-to-right brachial index was 1.0 ± 0.1. Results The mean total treatment length was 17.6 ± 8.9 cm; 8 patients were treated with a single 10-cm graft for isolated arch disease. The primary endpoint of device delivery and Branch Vessel patency was achieved in 100% of patients, without 30-day death, stroke, or permanent paraplegia. The median duration of hospitalization was 4.0 days. Type I endoleaks at completion angiography were observed in 4 patients, and all resolved by 1 month without reintervention. All side Branches were patent at 1 month. The Kaplan-Meier survival rate at 6 months was 94.7%. Conclusions Total endovascular repair of distal zone 2 arch aortic aneurysms can be achieved with a novel Branched arch endograft. Future studies will evaluate the feasibility of this approach for aneurysms encompassing the brachiocephalic trunk and left carotid artery.
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true lumen collapse in aortic dissection part ii evaluation of treatment methods in phantoms with pulsatile flow
Radiology, 2000Co-Authors: Jin Wook Chung, Christopher J Elkins, Toyohiko Sakai, Noriyuki Kato, Thomas Vestring, Charles P Semba, Suzanne M Slonim, Michael D DakeAbstract:PURPOSE: To discover and evaluate the effective treatment methods to prevent or relieve true-lumen collapse in models of aortic dissection. MATERIALS AND METHODS: Two phantoms were built to simulate type B aortic dissection. After true-lumen collapse was induced, experiments were conducted to evaluate the effectiveness of clinically relevant variables in relieving the collapse. Variables included entry-tear size, Branch-Vessel flow distribution, distal reentry communication between the true and false limbs, aortic fenestrations, and pump output. To test the effect of closing the entry tear, a stent-graft was deployed over the entry tear under physiologic conditions in a mock-flow loop. The difference in the effect of each variable on the prevention and relief of true-lumen collapse was also investigated. RESULTS: It was more difficult to relieve true-lumen collapse than it was to prevent it. Placement of a stent-graft over the entry tear was the most effective method of relieving true-lumen collapse. Less...
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true lumen collapse in aortic dissection part i evaluation of causative factors in phantoms with pulsatile flow
Radiology, 2000Co-Authors: Jin Wook Chung, Christopher J Elkins, Toyohiko Sakai, Noriyuki Kato, Thomas Vestring, Charles P Semba, Suzanne M Slonim, Michael D DakeAbstract:PURPOSE: To investigate the causative factors in true-lumen collapse in a model of aortic dissection. MATERIALS AND METHODS: Phantoms with an aortic arch, true and false lumina with abdominal Branch Vessels, and a distal bifurcation were used to model a Stanford type B aortic dissection. The effects of anatomic factors (entry-tear size, Branch-Vessel flow distribution, fenestrations, distal reentry communication) and physiologic factors (peripheral resistance in the Branch Vessels, pump output and rate, vascular compliance) on true-lumen collapse were investigated. The morphology of the true lumen was observed. Branch pressures and flow rates were measured. RESULTS: True-lumen collapse was induced and was exacerbated by an increase in the size of the entry tear, a decrease in the false-lumen outflow caused by occluding the false-lumen Branch Vessels, and an increase in the true-lumen outflow caused by lowering the peripheral resistance in true-lumen Branch Vessels. Two kinds of true-lumen collapse depended on pump output. With low purnp output and low outflow resistance from the true lumen, the true lumen collapsed. With high pump output and low inflow resistance in the false lumen, the true lumen was compressed. Distal reentry communication between the true and false limbs was more effective than aortic fenestrations in preventing true-lumen collapse. CONCLUSION: True-lumen collapse in this dissection model strongly depends on the difference in the ratios of inflow capacity to outflow capacity in the true and false lumina. Both anatomic and physiologic factors can affect true-lumen collapse.
Iana Simova - One of the best experts on this subject based on the ideXlab platform.
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comparison of standard renal denervation procedure versus novel distal and Branch Vessel procedure with brachial arterial access
Cardiovascular Revascularization Medicine, 2019Co-Authors: Ivo Petrov, Iveta Tasheva, Iskren Garvanski, Zoran Stankov, Iana SimovaAbstract:OBJECTIVES We assessed a novel approach to percutaneous renal denervation for uncontrolled hypertension consisting of ablation beyond the proximal main renal artery (Y-pattern), including the primary Branches, and compared it to the standard procedure applied only within the main Vessel. We also assessed the safety and practicality of a brachial access approach. METHODS AND RESULTS Renal denervation was performed on 119 consecutive patients (60 ± 13 years). In 68 of the patients, femoral arterial vascular approach was used and in 51 brachial. In 80 patients treated with the standard ablation, 12.0 ± 3.0 total ablations (both sides) were applied while 20.4 ± 3.9 total ablations were delivered for the group of 39 patients with Y-pattern denervation (P < 0.001). Technically successful renal denervation was achieved in all patients. Office blood-pressure levels at baseline were 170 ± 17/93 ± 10 mm Hg for the standard group and 169 ± 13/96 ± 9 mm Hg for the Y-pattern group. No major adverse events occurred during the procedure or in the postprocedural in-hospital period. Renal denervation was associated with significant decreases in both office and ambulatory systolic and diastolic blood pressure in both groups. The reduction in 24-hour mean ambulatory systolic blood pressure at 6 months was significantly greater (P = 0.002) for the Y-Pattern group (-22.1 ± 15.4 mm Hg) compared to the Standard group (-11.8 ± 16.2 mm Hg). Changes in diastolic office and ambulatory pressure were also significantly greater at 6 months in the Y-pattern ablation group. Indices of blood pressure variability improved in both groups. CONCLUSION Renal denervation using a Y-pattern ablation strategy combined with a greater number of lesions is safe and resulted in significant greater decreases in mean 24-hour ambulatory systolic and diastolic blood pressure compared to the conventional approach in this single-centre matched cohort study. Brachial artery access was shown to be feasible and safe for renal denervation.
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tct 31 comparison of standard renal denervation procedure versus novel distal and Branch Vessel procedure with brachial arterial access
Journal of the American College of Cardiology, 2018Co-Authors: Ivo Petrov, Iveta Tasheva, Iskren Garvanski, Zoran Stankov, Iana SimovaAbstract:We assessed a novel approach to percutaneous renal denervation for uncontrolled hypertension consisting of ablation beyond the proximal main renal artery (Y- pattern), including the primary Branches, and compared it to the standard procedure applied only within the main Vessel. We also assessed the
Jin Wook Chung - One of the best experts on this subject based on the ideXlab platform.
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true lumen collapse in aortic dissection part ii evaluation of treatment methods in phantoms with pulsatile flow
Radiology, 2000Co-Authors: Jin Wook Chung, Christopher J Elkins, Toyohiko Sakai, Noriyuki Kato, Thomas Vestring, Charles P Semba, Suzanne M Slonim, Michael D DakeAbstract:PURPOSE: To discover and evaluate the effective treatment methods to prevent or relieve true-lumen collapse in models of aortic dissection. MATERIALS AND METHODS: Two phantoms were built to simulate type B aortic dissection. After true-lumen collapse was induced, experiments were conducted to evaluate the effectiveness of clinically relevant variables in relieving the collapse. Variables included entry-tear size, Branch-Vessel flow distribution, distal reentry communication between the true and false limbs, aortic fenestrations, and pump output. To test the effect of closing the entry tear, a stent-graft was deployed over the entry tear under physiologic conditions in a mock-flow loop. The difference in the effect of each variable on the prevention and relief of true-lumen collapse was also investigated. RESULTS: It was more difficult to relieve true-lumen collapse than it was to prevent it. Placement of a stent-graft over the entry tear was the most effective method of relieving true-lumen collapse. Less...
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true lumen collapse in aortic dissection part i evaluation of causative factors in phantoms with pulsatile flow
Radiology, 2000Co-Authors: Jin Wook Chung, Christopher J Elkins, Toyohiko Sakai, Noriyuki Kato, Thomas Vestring, Charles P Semba, Suzanne M Slonim, Michael D DakeAbstract:PURPOSE: To investigate the causative factors in true-lumen collapse in a model of aortic dissection. MATERIALS AND METHODS: Phantoms with an aortic arch, true and false lumina with abdominal Branch Vessels, and a distal bifurcation were used to model a Stanford type B aortic dissection. The effects of anatomic factors (entry-tear size, Branch-Vessel flow distribution, fenestrations, distal reentry communication) and physiologic factors (peripheral resistance in the Branch Vessels, pump output and rate, vascular compliance) on true-lumen collapse were investigated. The morphology of the true lumen was observed. Branch pressures and flow rates were measured. RESULTS: True-lumen collapse was induced and was exacerbated by an increase in the size of the entry tear, a decrease in the false-lumen outflow caused by occluding the false-lumen Branch Vessels, and an increase in the true-lumen outflow caused by lowering the peripheral resistance in true-lumen Branch Vessels. Two kinds of true-lumen collapse depended on pump output. With low purnp output and low outflow resistance from the true lumen, the true lumen collapsed. With high pump output and low inflow resistance in the false lumen, the true lumen was compressed. Distal reentry communication between the true and false limbs was more effective than aortic fenestrations in preventing true-lumen collapse. CONCLUSION: True-lumen collapse in this dissection model strongly depends on the difference in the ratios of inflow capacity to outflow capacity in the true and false lumina. Both anatomic and physiologic factors can affect true-lumen collapse.
Ivo Petrov - One of the best experts on this subject based on the ideXlab platform.
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comparison of standard renal denervation procedure versus novel distal and Branch Vessel procedure with brachial arterial access
Cardiovascular Revascularization Medicine, 2019Co-Authors: Ivo Petrov, Iveta Tasheva, Iskren Garvanski, Zoran Stankov, Iana SimovaAbstract:OBJECTIVES We assessed a novel approach to percutaneous renal denervation for uncontrolled hypertension consisting of ablation beyond the proximal main renal artery (Y-pattern), including the primary Branches, and compared it to the standard procedure applied only within the main Vessel. We also assessed the safety and practicality of a brachial access approach. METHODS AND RESULTS Renal denervation was performed on 119 consecutive patients (60 ± 13 years). In 68 of the patients, femoral arterial vascular approach was used and in 51 brachial. In 80 patients treated with the standard ablation, 12.0 ± 3.0 total ablations (both sides) were applied while 20.4 ± 3.9 total ablations were delivered for the group of 39 patients with Y-pattern denervation (P < 0.001). Technically successful renal denervation was achieved in all patients. Office blood-pressure levels at baseline were 170 ± 17/93 ± 10 mm Hg for the standard group and 169 ± 13/96 ± 9 mm Hg for the Y-pattern group. No major adverse events occurred during the procedure or in the postprocedural in-hospital period. Renal denervation was associated with significant decreases in both office and ambulatory systolic and diastolic blood pressure in both groups. The reduction in 24-hour mean ambulatory systolic blood pressure at 6 months was significantly greater (P = 0.002) for the Y-Pattern group (-22.1 ± 15.4 mm Hg) compared to the Standard group (-11.8 ± 16.2 mm Hg). Changes in diastolic office and ambulatory pressure were also significantly greater at 6 months in the Y-pattern ablation group. Indices of blood pressure variability improved in both groups. CONCLUSION Renal denervation using a Y-pattern ablation strategy combined with a greater number of lesions is safe and resulted in significant greater decreases in mean 24-hour ambulatory systolic and diastolic blood pressure compared to the conventional approach in this single-centre matched cohort study. Brachial artery access was shown to be feasible and safe for renal denervation.
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tct 31 comparison of standard renal denervation procedure versus novel distal and Branch Vessel procedure with brachial arterial access
Journal of the American College of Cardiology, 2018Co-Authors: Ivo Petrov, Iveta Tasheva, Iskren Garvanski, Zoran Stankov, Iana SimovaAbstract:We assessed a novel approach to percutaneous renal denervation for uncontrolled hypertension consisting of ablation beyond the proximal main renal artery (Y- pattern), including the primary Branches, and compared it to the standard procedure applied only within the main Vessel. We also assessed the
Matthew J Eagleton - One of the best experts on this subject based on the ideXlab platform.
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impact of bridging stent design and configuration on Branch Vessel durability after fenestrated endovascular repair of complex aortic aneurysms
Journal of Vascular Surgery, 2020Co-Authors: Behzad S Farivar, Yuki Kuramochi, Corey Brier, Matthew J EagletonAbstract:Abstract Objective The ideal mating stent for target Vessel revascularization in fenestrated endovascular aneurysm repair (FEVAR) of juxtarenal and thoracoabdominal aortic aneurysms remains unknown. The objective of this study was to assess the outcomes associated with use of different stent types and configurations mated with reinforced fenestrations during FEVAR. Methods Clinical data from patients undergoing FEVAR for juxtarenal and thoracoabdominal aortic aneurysms in a prospective physician-sponsored investigational device exemption trial were analyzed. Outcomes for two different balloon-expandable covered stents (BECSs) mated with reinforced fenestrations were assessed along with the impact of distal extension with a self-expanding stent (SES). Primary patency, Branch-related endoleak, and reintervention rates were determined. Cox proportional hazards model was used for time-to-event analysis. Results From 2001 to 2016, there were 918 patients who underwent fenestrated or Branched endograft repair of complex aortic aneurysms; 1604 renal arteries (RAs), 714 superior mesenteric arteries (SMAs), and 333 celiac arteries (CAs) were mated with reinforced fenestrations using JOMED (n = 2014; Abbott Vascular, Santa Clara, Calif) or iCAST (n = 637; Atrium Medical, Hudson, NH) BECSs. The type of BECS did not affect short-term or long-term patency, Branch-related endoleaks, or reintervention rates in the RA, SMA, or CA. Twenty-five percent (402/1604) of RAs, 84% (598/714) of SMAs, and 8% (27/333) of CAs underwent distal SES extension at the index operation. RAs with a distal SES in addition to the BECS had a higher likelihood of an occlusion event (hazard ratio, 2.791; 95% confidence interval, 1.42-5.48; P = .003) and reinterventions (P = .036) compared with those without an SES. Addition of a distal SES to the BECS in the SMA or CA did not have an impact on patency or reintervention rates. Conclusions BECS choice does not appear to have an impact on Branch durability after FEVAR. Selective distal SES placement in RAs with high-risk anatomy does not appear to significantly protect against an occlusion event or to prevent secondary interventions. Routine addition of a distal SES does not improve SMA fenestration durability.
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impact of alterations in target Vessel curvature on Branch durability after endovascular repair of thoracoabdominal aortic aneurysms
Journal of Vascular Surgery, 2016Co-Authors: Joshua Sylvan, Yuki Kuramochi, Corey Brier, Katherine Wolski, Jeffrey Yanof, Vikash Ravi Goel, Matthew J EagletonAbstract:Objective The aim of this study was to evaluate curvature and its effect on the durability of visceral and renal Branches in patients undergoing endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) with fenestrated/Branched endovascular aneurysm repair (F/B-EVAR). Methods Quantitative Branch Vessel curvature assessment on Branches arising from reinforced fenestrations was performed for 168 patients undergoing F/B-EVAR for type II and type III TAAAs. Preoperative and postoperative centerline coordinates were obtained using iNtuition (TeraRecon, Foster City, Calif) and exported into MATLAB (The MathWorks, Inc, Natick, Mass) based on thin-slice computed tomography imaging. Spline interpolation was applied to the centerline coordinates and resampled at 100 equally spaced points, and curvature calculations (κ, mm −1 ) were applied. Global and maximal curvatures for each of the target Vessels were measured and categorized by severity. Categories for curvature were 0 to 0.05 mm −1 (low), 0.05 to 0.1 mm −1 (medium), 0.1 to 0.15 mm −1 (high), and >0.15 mm −1 (extreme) for global curvature and 0 to 0.2 mm −1 , 0.2 to 0.4 mm −1 , 0.4 to 0.6 mm −1 , and >0.6 mm −1 , respectively, for maximum curvature. Curvature variances were assessed for an association with Vessel patency and need for reintervention. Results There were 558 Vessels that underwent analysis based on repairs involving 650 Vessels, whereby 92 Vessels were excluded as they were treated with an external helical Branch (58 celiac arteries and 34 superior mesenteric arteries). There was a significant difference found before and after F/B-EVAR for the global celiac artery curvature (median difference, −0.01; P P = .014), maximum left renal artery curvature (median, 0.05; P P = .009). Maximum artery curvature was found to have shifted distally in all Vessels postoperatively; 37 adverse events (AEs) were observed in 30 patients (6 Branched occlusions and 31 reinterventions [24 type III endoleaks, 5 Vessel stenoses, and 2 Vessel occlusions]). The majority of AEs (>70%) occurred within the range of low to medium curvature. Univariate analysis found gender to be a dependent variable associated with high (maximum) preoperative curvature (odds ratio, 0.395; P = .02). The use of self-expanding stents (vs balloon-expandable stents alone) in Vessels with high preoperative curvature (>0.6 mm −1 ) was significant in the right renal artery ( P = .044). Conclusions This study did not show a significant relationship between the severity of artery curvature or changes in curvature and AEs found for visceral or renal Branches after F/B-EVAR for extensive TAAA. Surprisingly, the majority of AEs occurred in low- and medium-curved Vessels. This study is limited in that it does not take into account other factors that may affect AEs, like motion, which would be valuable in future studies.
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outcomes for supra aortic Branch Vessel stenting in the treatment of thoracic aortic disease
Journal of Vascular Surgery, 2014Co-Authors: Adrian Ocallaghan, Tara M Mastracci, Roy K Greenberg, Matthew J Eagleton, James Bena, Yuki KuramochiAbstract:Objective Endovascular options for the treatment of proximal thoracic and arch disease have evolved over the years. In this manuscript, we review the midterm results of fenestrated compared with chimney configurations for proximal aortic aneurysm disease. Methods We performed an analysis of all patients with chimney grafts or custom fenestrated endografts used for treatment of proximal thoracic aneurysm disease (involving the supra-aortic trunk Vessels) presenting to our institution between 2004 and 2013. Patients were identified by retrospective chart review and through the prospective database (National Institutes of Health study number NCT00583050). Details of devices placed, intraoperative details, and measurements from postoperative imaging were included in the analysis. The primary outcomes of interest were long-term freedom from Branch stent complications and freedom from proximal endoleak, but we also included perioperative events, in-hospital mortality, and requirement for secondary interventions in our review. The log-rank test (Mantel-Cox) was used to compare survival data. Student t -test (two tailed) and Fisher exact test (two tailed) were used for continuous and categorical data, respectively. Results Of 767 patients who underwent thoracic endovascular repair from January 2004 to February 2013, 33 satisfied the inclusion criteria (4%): 18 of 33 noncustom and 15 of 33 custom graft designs. Overall, the rate of technical success was 97%. There were four Branch stent-related problems in the follow-up period, one of 15 (7%) in the custom group and three of 18 (17%) in the noncustom group. There were three proximal sealing failures in the immediate postoperative and follow-up period, one of 15 (7%) in the custom group and two of 18 (11%) in the noncustom group. Overall, 10 patients underwent secondary procedures, four of 15 (27%) in the custom group and six of 18 (33%) in the noncustom group. Conclusions Although they are technically feasible, both custom fenestrated endografts and chimney repairs for proximal thoracic disease involving the supra-aortic trunk Vessels suffer from failures in intermediate follow-up, with a trend toward better long-term outcomes for custom devices. More work is needed to develop durable devices for this anatomic territory in the future.