Yilang Xiang1, Chenyang Qiu1, Yangyan He1, Donglin Li1, Tao Shang1, Ziheng Wu2, Hongkun Zhang3. 1. Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China. 2. Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China. Electronic address: wuziheng@zju.edu.cn. 3. Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China. Electronic address: 1198050@zju.edu.cn.
Abstract
BACKGROUND: To report the early results and technical details of in situ needle fenestration during thoracic endovascular aortic repair (TEVAR). MATERIALS AND METHODS: Thirty-seven patients with thoracic aortic disease who underwent TEVAR with in situ needle fenestration in our department between February 2016 and April 2017 were included in this study. Their demographic information, clinical manifestations, periprocedural outcomes, and follow-up results were analyzed. RESULTS: In total, 96.4% of attempted fenestrations were successful (53/55). Fenestration of the left subclavian artery (LSA) was performed in 26 patients, fenestration of either the LSA or brachiocephalic trunk (BCT) plus the left common carotid artery (LCCA) was performed in six patients, and fenestration of the three supra-aortic branches was performed in five patients. In the three-fenestration group with five patients, the procedure was under the protection of a cardiopulmonary bypass. External iliac artery rupture occurred in one case. Cerebrovascular events occurred in three cases, and myocardial infarction occurred in one. One case had a branch stent graft stuck in the brachial artery. During a median follow-up of 21 months, two patients developed retrograde type A dissection, and one was subsequently treated with a stent graft and BCT fenestration. One case presented with numbness in the fingertips of the left hand, and computed tomography angiography (CTA) indicated stenosis of the branch stent in the LSA. CTA examination revealed no endoleaks or expansion of the aortic aneurysms in any of the patients. CONCLUSIONS: In situ needle fenestration of endografts in the aortic arch is technically feasible, yielding acceptable short-term results in a selected patient cohort. Further studies are needed to determine mid- and long-term outcomes before more widespread adoption.
BACKGROUND: To report the early results and technical details of in situ needle fenestration during thoracic endovascular aortic repair (TEVAR). MATERIALS AND METHODS: Thirty-seven patients with thoracic aortic disease who underwent TEVAR with in situ needle fenestration in our department between February 2016 and April 2017 were included in this study. Their demographic information, clinical manifestations, periprocedural outcomes, and follow-up results were analyzed. RESULTS: In total, 96.4% of attempted fenestrations were successful (53/55). Fenestration of the left subclavian artery (LSA) was performed in 26 patients, fenestration of either the LSA or brachiocephalic trunk (BCT) plus the left common carotid artery (LCCA) was performed in six patients, and fenestration of the three supra-aortic branches was performed in five patients. In the three-fenestration group with five patients, the procedure was under the protection of a cardiopulmonary bypass. External iliac artery rupture occurred in one case. Cerebrovascular events occurred in three cases, and myocardial infarction occurred in one. One case had a branch stent graft stuck in the brachial artery. During a median follow-up of 21 months, two patients developed retrograde type A dissection, and one was subsequently treated with a stent graft and BCT fenestration. One case presented with numbness in the fingertips of the left hand, and computed tomography angiography (CTA) indicated stenosis of the branch stent in the LSA. CTA examination revealed no endoleaks or expansion of the aortic aneurysms in any of the patients. CONCLUSIONS: In situ needle fenestration of endografts in the aortic arch is technically feasible, yielding acceptable short-term results in a selected patient cohort. Further studies are needed to determine mid- and long-term outcomes before more widespread adoption.