{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:11:59Z","timestamp":1790122319541,"version":"4.0.1"},"reference-count":27,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,12,25]],"date-time":"2024-12-25T00:00:00Z","timestamp":1735084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Few clinical studies have reported on physician-modified inner-branched endovascular repair (PMiBEVAR) for aortic arch aneurysm. Herein, we evaluate the outcomes of proximal landing zone 2 PMiBEVAR. Methods: This retrospective study analyzed data from six patients who underwent zone 2 PMiBEVAR for aortic arch aneurysms at a single center between October 2021 and June 2024. The outcomes were in-hospital mortality and postoperative complications. Results: The median follow-up period was 12.5 (7.3\u201325) months. Males constituted four out of six cases and females constituted two out of six cases. The patients had a median age of 78.5 (76.5\u201379.0) years, and the aneurysm diameter was 56 (50\u201361) mm. Technical success was achieved in 5\/6 (83.3%) cases. The median modification and operative times were 56 (45\u201360) min and 92 (79\u2013308), respectively. Postoperatively, delayed type Ia endoleak and vascular access-site pseudoaneurysm occurred in one patient each. However, no patients experienced other complications. The median hospital stay was 10 (7\u201341) days, and no deaths or reinterventions occurred after 30 days. During the post-discharge follow-up, the aneurysm diameter remained \u201cunchanged\u201d in four patients, including the one with delayed type Ia endoleak, while two patients experienced \u201cshrinkage\u201d. Conclusions: PMiBEVAR for distal aortic arch aneurysm might be effective in improving postoperative outcomes.<\/jats:p>","DOI":"10.3390\/jcm14010039","type":"journal-article","created":{"date-parts":[[2024,12,25]],"date-time":"2024-12-25T19:29:52Z","timestamp":1735154992000},"page":"39","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Initial Outcomes of Physician-Modified Inner-Branched Endovascular Repair for Distal Aortic Arch Aneurysm"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5359-5349","authenticated-orcid":false,"given":"Shingo","family":"Tsushima","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo 060-8556, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4105-2937","authenticated-orcid":false,"given":"Tsuyoshi","family":"Shibata","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo 060-8556, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Iba","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo 060-8556, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiro","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo 060-8556, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junji","family":"Nakazawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo 060-8556, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhei","family":"Miura","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo 060-8556, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayaka","family":"Arihara","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo 060-8556, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Mukawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo 060-8556, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Iwashiro","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo 060-8556, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyoshi","family":"Kawaharada","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo 060-8556, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Shi, R., and Wooster, M. (2024). Hybrid and Endovascular Management of Aortic Arch Pathology. J. Clin. Med., 13.","DOI":"10.3390\/jcm13206248"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1016\/j.jvs.2021.12.068","article-title":"Surgical debranching versus branched endografting in zone 2 thoracic endovascular aortic repair","volume":"75","author":"Squiers","year":"2022","journal-title":"J. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"D\u2019Onofrio, A., Caraffa, R., Cibin, G., Antonello, M., and Gerosa, G. (2022). Total endovascular aortic arch repair: From dream to reality. Medicina, 58.","DOI":"10.3390\/medicina58030372"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.2147\/CIA.S222948","article-title":"Outcomes of chimney technique for aortic arch diseases: A single-center experience with 226 cases","volume":"14","author":"Huang","year":"2019","journal-title":"Clin. Interv. Aging"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.1016\/j.jvs.2019.06.205","article-title":"Fenestrated endovascular repair for diseases involving the aortic arch","volume":"71","author":"Tsilimparis","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1177\/15266028211059439","article-title":"Physician-modified endograft with triple inner branches for extensive aortic arch aneurysm","volume":"29","author":"Zhang","year":"2022","journal-title":"J. Endovasc. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Shibata, T., Iba, Y., Nakajima, T., Nakazawa, J., Ohkawa, A., Hosaka, I., Arihara, A., Tsushima, S., Ogura, K., and Yoshikawa, K. (2023). Initial outcomes of physician-modified inner branched endovascular repair in high-surgical-risk patients. J. Endovasc. Ther., 15266028231169183.","DOI":"10.1177\/15266028231169183"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"55S","DOI":"10.1016\/j.jvs.2020.05.076","article-title":"Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms","volume":"73","author":"Upchurch","year":"2021","journal-title":"J. Vasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1253\/circj.CJ-22-0794","article-title":"JCS\/JSCVS\/JATS\/JSVS 2020 guideline on diagnosis and treatment of aortic aneurysm and aortic dissection","volume":"87","author":"Ogino","year":"2023","journal-title":"Circ. J."},{"key":"ref_10","first-page":"111","article-title":"New classification of physical status","volume":"24","author":"Dripps","year":"1963","journal-title":"Anesthesiology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.jvs.2010.07.008","article-title":"Reporting standards for thoracic endovascular aortic repair (TEVAR)","volume":"52","author":"Fillinger","year":"2010","journal-title":"J. Vasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1093\/ejcts\/ezt615","article-title":"How should aortic arch aneurysms be treated in the endovascular aortic repair era? A risk-adjusted comparison between open and hybrid arch repair using propensity score-matching analysis","volume":"46","author":"Iba","year":"2014","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1016\/j.jvs.2016.03.410","article-title":"Branched versus fenestrated endografts for endovascular repair of aortic arch lesions","volume":"64","author":"Tsilimparis","year":"2016","journal-title":"J. Vasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1177\/1526602817714206","article-title":"Physician-modified thoracic stent-grafts for the treatment of aortic arch lesions","volume":"24","author":"Canaud","year":"2017","journal-title":"J. Endovasc. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Ye, J., Li, Y., Lu, Y., Wang, Y., Liu, B., and Chang, H. (2023). Homemade fenestration and chimney techniques for the left subclavian artery revascularization during zone 2 thoracic endovascular aortic repair. Front. Cardiovasc. Med., 31.","DOI":"10.3389\/fcvm.2023.1144751"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.xjtc.2020.04.009","article-title":"Endovascular exclusion of the entire aortic arch with branched stent-grafts after surgery for acute type A aortic dissection","volume":"3","author":"Cibin","year":"2020","journal-title":"JTCVS Tech."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.jvs.2019.11.046","article-title":"Off-the-shelf multibranched endograft for total endovascular repair of the aortic arch","volume":"72","author":"Bosse","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Rizza, A., Trimarchi, G., Di Sibio, S., Bastiani, L., Murzi, M., Palmieri, C., Foffa, I., and Berti, S. (2023). Preliminary Outcomes of Zone 2 Thoracic Endovascular Aortic Repair Using Castor Single-Branched Stent Grafts: A Single-Center Experience. J. Clin. Med., 12.","DOI":"10.3390\/jcm12247593"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Yordanov, M.D., Oberhuber, A., and Ibrahim, A. (2022). Physician-Modified TEVAR versus Hybrid Repair of the Proximal Descending Thoracic Aorta. J. Clin. Med., 11.","DOI":"10.3390\/jcm11123455"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1177\/1526602819890108","article-title":"Physician-modified endograft with double inner branches for urgent repair of supraceliac para-anastomotic pseudoaneurysm","volume":"27","author":"Mirza","year":"2020","journal-title":"J. Endovasc. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"ezae404","DOI":"10.1093\/ejcts\/ezae404","article-title":"Multicentre retrospective analysis of physician-modified fenestrated\/inner-branched endovascular repair for complex aortic aneurysms","volume":"66","author":"Shibata","year":"2024","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1177\/15266028211061275","article-title":"Physician-Modified Endograft with Inner Branches for the Treatment of Complex Aortic Urgencies","volume":"29","author":"Torrealba","year":"2022","journal-title":"J. Endovasc. Ther."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/j.jvs.2022.10.041","article-title":"Analysis of predisposing factors for type III endoleaks from directional branches after branched endovascular repair for thoracoabdominal aortic aneurysms","volume":"77","author":"Gennai","year":"2023","journal-title":"J. Vasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1016\/j.jvs.2019.10.068","article-title":"Secondary interventions after fenestrated and branched endovascular repair of complex aortic aneurysms","volume":"72","author":"Silverberg","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1016\/j.jvs.2020.09.036","article-title":"Revascularization of occluded renal artery stent grafts after complex endovascular aortic repair and its impact on renal function","volume":"73","author":"Konstantinou","year":"2021","journal-title":"J. Vasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1177\/15266028231163069","article-title":"Early results and feasibility of total endovascular aortic arch repair using 3-vessel company-manufactured and physician-modified stent-grafts","volume":"31","author":"Lee","year":"2024","journal-title":"J. Endovasc. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"DiBartolomeo, A.D., Kazerounim, K., Fleischman, F., and Han, S.M. (2024). The initial results of physician-modified fenestrated-branched endovascular repairs of the aortic arch and lessons learned from the first 21 cases. J. Endovasc. Ther., 15266028241255539.","DOI":"10.1177\/15266028241255539"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/1\/39\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T17:00:05Z","timestamp":1760115605000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/1\/39"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,25]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14010039"],"URL":"https:\/\/doi.org\/10.3390\/jcm14010039","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,25]]}}}