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wire. After endograft predilation, an Atrium ICAST 8-to 10-mm stent is deployed approximately one-quarter into the lumen and three-quarters into the branch vessel. The endograft portion of the covered stent is then flared and a completion angiogram performed.Results: Six patients (3 men, 3 women), mean age of 50 years, underwent left SCA laser fenestration with TEVAR. All had hypertension, and four (67%) had a history of smoking, hypercholesterolemia, or congestive heart disease. Two patients had Marfan syndrome and two patients had previous aortic root replacement. Five patients had acute dissections, two with an intramural hematoma. One patient had a penetrating aortic ulcer distal to the left SCA after previous ascending aortic repair. Mean aortic size was 43 mm (range, 28-80 mm). Mean contrast volume was 101 Ϯ 51 mL. Mean operative time was 180 Ϯ 38 minutes. Technical success was 83% (n ϭ 5). One fenestration attempt was abandoned secondary to the acute angle of the SCA and a type III aortic arch. The SCA stent in this case was snorkeled into the aorta proximal to the endograft, revascularizing the SCA with no clinical consequences. Mean length of hospital stay was 9 Ϯ 3 days. At the mean follow-up of 5.2 months (range, 1-11 months), all SCA stents were patent with no fenestration-related endoleaks. There were also no fenestration-related complications. One patient underwent aortic root replacement of a retrograde aortic dissection. Mortality for our patient population was zero.Conclusion: In situ retrograde laser fenestration is an innovative, feasible, and effective option for revascularizing the SCA during TEVAR.

Endovascular repair for abdominal aortic aneurysms (EVAR) has evolved as a common treatment for this disease entity. Although it provides outstanding early and mid-term results, the use of EVAR requires vigilant follow-up to insure that delayed complications—such as endoleaks–do not complicate an initially successful procedure. The optimal modality for detection of this entity remains undetermined. We present the case of a 77-year-old woman with a type I proximal endoleak identified on duplex ultrasound examination 1 month postoperatively. It was confirmed with computed tomography scanning and contrast aortography. The diameter of the aneurysm sac had increased from 5.8 cm (preoperatively) to 6.0 cm, prompting consideration of an intervention to address the endoleak. Repeat duplex examination, performed immediately before the planned repair, failed to demonstrate the endoleak, and the aneurysm sac measured 5.6 cm. This case report demonstrates the ability of duplex ultrasound to identify endoleaks and its importance in the close follow-up of patients who have undergone EVAR.