Early Feasibility of Endovascular Repair of Distal Aortic Arch Aneurysms Using Patient-Specific Single Retrograde Left Subclavian Artery Branch Stent Graft

Abstract

Objective To describe the feasibility and outcomes of endovascular repair of distal aortic arch aneurysms using a patient-specific stent graft with a pre-loaded single retrograde left subclavian artery (LSA) branch stent graft. Methods We reviewed the clinical data and outcomes of consecutive patients enrolled in an ongoing prospective, non-randomized physician-sponsored investigational device exemption study to evaluate the outcomes of endovascular aortic arch repair using patient-specific arch branch stent grafts (William Cook Europe, Bjaeverskov, Denmark) between 2019 and 2022. All patients received a design with triple-wide scallop and a single retrograde LSA branch with a pre-loaded catheter. Results There were five male patients with median age of 77 years old (72–80) treated using the single LSA branch stent graft. Technical success was achieved in all patients. Median operating time, fluoroscopy time, and total radiation dose area product were 103 (78–134) minutes, 26 (19–39) minutes, and 123 (71–270) mGy.cm 2 , respectively. There were no 30-day or in-hospital mortality, neurological or other major adverse events (MAEs). During median follow-up of 21 (20–27) months, all patients were alive with patent LSA branches, except for one who died of COVID-19 complications. There was no branch instability or secondary interventions. Conclusion This early feasibility study demonstrates successful endovascular repair of distal aortic arch aneurysms using a patient-specific stent graft with single retrograde LSA branch without technical failures, mortality or neurological events. Larger clinical experience and longer follow-up are needed to determined effectiveness of this approach in patients who need endovascular repair with proximal extension into Zone 2.

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“…Another independent study investigated the feasibility of endovascular repair of distal aortic arch aneurysms using a patient-specific single retrograde left subclavian artery branch stent graft (Wong et al, 2023). The results showed good recovery in all patients, with no serious complications or deaths.…”

“…Figure 3. A bilateral percutaneous femoral approach, guided by duplex ultrasound, was employed using a pre-closure technique Source: (Wong et al, 2023) Systemic heparinization was performed, and a Lunderquist wire was positioned in the ascending aorta. Angiography identified supra-aortic trunks, and the arch branch stent graft was introduced and deployed with careful calibration.…”

“…In addition to MSC therapy, advances in endovascular technology have revolutionized the treatment of aortic arch aneurysms. This study was published in the journal Cardiovascular and Interventional Radiology by (Wong et al, 2023). A study investigated the feasibility of endovascular repair with a patient-specific stent graft including a single retrograde left subclavian artery branch for distal aortic arch aneurysms.…”

In situ laser fenestration of the Thoraflex Hybrid frozen elephant trunk for emergent revascularization of the left subclavian artery and laser fenestration for spinal cord perfusion

“…Endovascular options include branched and fenestrated devices, which have limited off-the-shelf availability, especially in the European market. 6 Parallel graft technology, such as snorkels or chimneys, is available in the emergency setting but is limited by its vulnerability to gutter leakage. 7 , 8 …”

Single branch arch stent graft combined with laser fenestration in the treatment of a zone two penetrating thoracic aortic ulcer

“…The current case represents a PAU in a complex anatomic position, for which both open and endovascular options would be challenging. 15 , 16 , 17 , 18 In one study, 24 patients with zone 2 lesions were treated with 94% technical success. 19 After 16 months of follow-up, uniform PAU thrombosis was present but with two branch occlusions.…”