Yoshiaki Katada1, Shunichi Kondo2, Eitoshi Tsuboi2, Kyu Rokkaku2, Yoshihito Irie2, Hitoshi Yokoyama3. 1. Department of Cardiovascular Surgery, Iwaki Kyoritsu General Hospital, Fukushima, Japan; Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: ktd-tmd@umin.ac.jp. 2. Department of Cardiovascular Surgery, Iwaki Kyoritsu General Hospital, Fukushima, Japan. 3. Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Japan.
Abstract
BACKGROUND: Total arch replacement and ascending aorta and arch replacement are the gold standard treatments for aortic arch aneurysm and are possible treatment strategies for chronic type A dissection, with good reported outcomes. However, because total arch replacement is extremely invasive, it can be difficult to perform in some patients. We designed an endovascular total arch repair procedure with the use of in situ fenestration and commercially available devices, and we present our initial experience. METHODS: Seven patients (chronic type A aortic dissection, n = 3; thoracic arch aneurysm, n = 4) who underwent endovascular total arch repair with the use of in situ fenestration thoracic endovascular aortic repair from a zone 0 landing were retrospectively analyzed. All the procedures were performed under general anesthesia and cardiopulmonary bypass. The triple branches were manually punctured in a retrograde manner with the use of an 18-gauge/30-cm needle or a 21-gauge aspiration needle, and all the branches were reconstructed with the use of stent grafts; balloon touch-up was performed if appropriate. RESULTS: The procedure was successful in 6 of the 7 patients; the remaining 1 patient additionally underwent an axillary-axillary artery bypass during the operation because the left subclavian artery was difficult to puncture. All the patients had an acceptable postoperative course, with no 30-day and in-hospital deaths. None of the patients had endoleaks, and all the patients exhibited a reduction in aneurysm diameter or thrombosed false lumen during a mean follow-up period of 17.6 months. CONCLUSIONS: Endovascular total arch repair with the use of in situ fenestration can be performed with commercially available devices with acceptable interim results.
BACKGROUND: Total arch replacement and ascending aorta and arch replacement are the gold standard treatments for aortic arch aneurysm and are possible treatment strategies for chronic type A dissection, with good reported outcomes. However, because total arch replacement is extremely invasive, it can be difficult to perform in some patients. We designed an endovascular total arch repair procedure with the use of in situ fenestration and commercially available devices, and we present our initial experience. METHODS: Seven patients (chronic type A aortic dissection, n = 3; thoracic arch aneurysm, n = 4) who underwent endovascular total arch repair with the use of in situ fenestration thoracic endovascular aortic repair from a zone 0 landing were retrospectively analyzed. All the procedures were performed under general anesthesia and cardiopulmonary bypass. The triple branches were manually punctured in a retrograde manner with the use of an 18-gauge/30-cm needle or a 21-gauge aspiration needle, and all the branches were reconstructed with the use of stent grafts; balloon touch-up was performed if appropriate. RESULTS: The procedure was successful in 6 of the 7 patients; the remaining 1 patient additionally underwent an axillary-axillary artery bypass during the operation because the left subclavian artery was difficult to puncture. All the patients had an acceptable postoperative course, with no 30-day and in-hospital deaths. None of the patients had endoleaks, and all the patients exhibited a reduction in aneurysm diameter or thrombosed false lumen during a mean follow-up period of 17.6 months. CONCLUSIONS: Endovascular total arch repair with the use of in situ fenestration can be performed with commercially available devices with acceptable interim results.