{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T22:45:43Z","timestamp":1790117143840,"version":"4.0.1"},"reference-count":20,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2020,4,3]],"date-time":"2020-04-03T00:00:00Z","timestamp":1585872000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Endovasc Ther"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:p>Purpose: To identify the optimal proximal landing zone for thoracic aortic endovascular repair (TEVAR) of aortic arch pathologies so as to avoid the bird-beak phenomenon that leads to type Ia endoleak. Materials and Methods: A retrospective single-center review was conducted of 164 patients (mean age 70.3\u00b110.8 years, range 29\u201393; 127 men) who underwent repairs of the aortic arch using hybrid TEVAR from April 2008 to March 2017. The patients were divided into 2 groups according to the proximal landing zone: 43 zone 0 patients (26.2%) had total debranching TEVAR (n=18) or total endovascular aortic repair (n=25) while 121 patients (73.8%) had TEVAR landing in zones 1 (n=41) or 2 (n=80). Bird-beak configurations, endoleaks, and stent migrations were assessed on the postoperative and latest computed tomography angiography (CTA) scans. Overall survival and freedom from the bird-beak configuration, aorta-related death, and aortic events were estimated using the Kaplan-Meier method. Hazard ratios (HR) were calculated with the 95% confidence interval (CI). Results: All procedures were successful, without any 30-day mortality. There were 3 early complications (1.8%; all strokes) and 10 early endoleaks (6.1%; no type Ia). On the first postoperative CTA, 42 patients (25.6%) had a bird-beak configuration. The zone 0 patients had significantly fewer (p&lt;0.001), shorter (p&lt;0.004), and less angulated (p&lt;0.001) bird-beak configurations than in zones 1\u20132. The mean follow-up period was 4.2 years (range 0.5\u20138.8). There were 18 late deaths (11.0%); only one was related to the aorta (rupture due to a type Ib endoleak in a zone 0 patient). The 5-year freedom from aorta-related death was not significantly different between groups (zone 0: 96.9% vs zones 1\u20132: 100%, p=0.080). On the latest CTA, 51 (31.0%) patients had a bird-beak configuration; of those, 22 (13.4%) showed &gt;3-mm progression. The freedom from bird-beak configuration estimate was significantly higher in the zone 0 group (95.4%) vs zones 1\u20132 (57.8%; HR 0.10, 95% CI 0.02 to 0.31, p&lt;0.001). There were 9 late endoleaks (4 type Ia; none in the zone 0 group). The rate of stent-graft migration was significantly lower in the zone 0 group (2.3% vs 14.1% in zones 1\u20132, p=0.035). Conclusion: Early and most late results in zone 0 TEVAR were equal to those in zones 1 and 2; however, there were no late type Ia endoleaks and fewer bird-beak configurations associated with zone 0 TEVAR, which suggests that zone 0 landing is advantageous for preventing these complications.<\/jats:p>","DOI":"10.1177\/1526602820914269","type":"journal-article","created":{"date-parts":[[2020,4,3]],"date-time":"2020-04-03T08:55:18Z","timestamp":1585904118000},"page":"368-376","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":39,"title":["Determining the Optimal Proximal Landing Zone for TEVAR in the Aortic Arch: Comparing the Occurrence of the Bird-Beak Phenomenon in Zone 0 vs Zones 1 and 2"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6257-4160","authenticated-orcid":false,"given":"Tomoaki","family":"Kudo","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Kuratani","sequence":"additional","affiliation":[{"name":"Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuo","family":"Shimamura","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiki","family":"Sawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,4,3]]},"reference":[{"key":"bibr1-1526602820914269","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezt391"},{"key":"bibr2-1526602820914269","doi-asserted-by":"publisher","DOI":"10.1007\/s00270-012-0383-3"},{"key":"bibr3-1526602820914269","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2011.06.024"},{"key":"bibr4-1526602820914269","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2015.04.018"},{"key":"bibr5-1526602820914269","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.108.819722"},{"key":"bibr6-1526602820914269","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2013.07.098"},{"key":"bibr7-1526602820914269","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezx254"},{"key":"bibr8-1526602820914269","first-page":"292","volume":"3","author":"Kuratani T.","year":"2014","journal-title":"Ann Cardiothorac 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