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ludc webb

Nuno Dias

Adjunct professor

ludc webb

Distal landing zone outcomes in thoracic endovascular aortic aneurysm repair with challenging morphology : a propensity-matched comparison of distal active fixation versus standard stent-graft


  • Stefano Gennai
  • Nicola Leone
  • Angelos Karelis
  • Andrea Xodo
  • Luca Mezzetto
  • Aaron Fargion
  • Michele Antonello
  • Gian Franco Veraldi
  • Nuno V Dias
  • Björn Sonesson
  • Carlo Pratesi
  • Roberto Silingardi

Summary, in English

BACKGROUND: To evaluate the distal landing zone (LZ) outcomes in adverse morphology after thoracic endovascular repair (TEVAR) with distal active fixation (DAF) stent-grafts compared with standard endografts.

METHODS: between 2006 and the 31st December 2020, sixty-nine DAFs (study group) and sixty-nine standard stent-grafts (control group) were enrolled in a multi-center, retrospective, case-control study. The primary outcomes were the distal endoleak and reintervention. The secondary outcomes were: distal segment migration, wedge apposition and related complications. A univariate and multivariate logistic regression followed by a propensity-scored model (1:1) were performed.

RESULTS: The results were reported for the DAF vs control group. The mean follow-up was 3.3 ± 2.1 vs 3.7 ± 3.4 years. The distal endoleak rate was 7.3% vs 27.5% (P=0.011). The freedom from distal endoleak was 95%, 95% and 91% vs 85%, 76%, and 73% at 1, 3 and 5 years respectively (Log-rank P=0.011). Tortuosity index and distal thoracic aorta angulation were predictors of endoleak (P=0.012 and P=0.029 respectively). The distal reinterventions rate was 7.3% vs 20.3% (P=0.026). The freedom from distal reinterventions was 95%, 95% and 91% vs 92%, 75% and 75% at 1, 3 and 5 years respectively (Log-rank P=0.041). The wedge apposition was 5.8 vs 13.0-mm (P<0.000). The distal segment migration was upward directed in all cases and was significant (>10- mm) in 13.0% vs 39.1% (P=0.000).

CONCLUSIONS: The DAF stent-graft showed a significant reduction of the distal endoleak rates and other specific outcomes of the distal LZ in patients with an adverse anatomy.

Publishing year







International Angiology





Document type

Journal article


Minerva Medica


  • Cardiac and Cardiovascular Systems




  • ISSN: 1827-1839