Homemade proximal scalloped stent graft for thoracic endovascular aortic repair of zone 2 acute aortic syndrome

Abstract

The use of the homemade proximal scalloped stent graft is both feasible and effective for left subclavian artery revascularization during thoracic endovascular aortic repair involving a spectrum of acute thoracic aortic pathology. This approach provides a rapid, reproducible method of scalloping the endograft. Durability concerns will need to be assessed in additional studies with long-term follow-up.

Midterm Follow-up of Fenestrated and Scalloped Physician-Modified Endovascular Grafts for Zone 2 TEVAR

“…Our group has previously demonstrated the technical feasibility and short-term safety of TEVAR with either a scallop or fenestration for the LSA. 12–15 Although our fenestration technique cuts only the stent-graft fabric leaving the struts intact, in our earlier reports we expressed concern about the long-term durability of this approach. Metal fatigue and material deterioration are known complications of stent-grafting, 18 and it has been hypothesized that custom-modified stent-grafts in the arch may be particularly vulnerable due to the asymmetric force distribution.…”

“…These aspects have already been described in detail for both scalloped and fenestrated TEVAR in our previous publications. [12][13][14][15] In summary, procedure planning and device sizing were performed using a dedicated 3-dimensional vascular imaging workstation [either Aquarius WS (Terarecon Inc., San Mateo, CA, USA) or OsiriX Imaging Software (OsiriX, Geneva, Switzerland) until 2017, when the EndoSize 3D vascular imaging workstation (Therenva, Nanjing, France) became available. Center lumen line reconstruction was used to determine aortic diameter at the landing zones and measure lengths.…”

“…The world experience with these strategies is both limited and without long-term follow-up. We have reported our experience [12][13][14][15] in the use of PMEGs for TEVAR with proximal landing in zones 0, 1, and 2. This retrospective analysis reviews the midterm outcomes of those TEVAR patients treated with PMEGs in zone 2.…”

Homemade fenestrated stent-graft for thoracic endovascular aortic repair of zone 2 aortic lesions

“…We have already reported the use of homemade proximal scalloped stent-grafts for TEVAR of zone 2 acute aortic syndromes. 9 However, patients are only considered suitable for a scalloped stent-graft if the minimum healthy aorta is at least 15 mm from the expected position of the edge of the scallop, both proximally and laterally. Therefore, several patients are not eligible for this approach, especially for lesions involving the outer curve of the aortic arch.…”

Experimental Assessment of Physician Modified Proximal Scalloped Stent Graft to Extend Proximal Landing Zone in the Aortic Arch

“…Based on the concept of a physician modified fenestrated stent graft to treat an emergency aneurysm involving the visceral aorta, 4 use of a physician modified proximal scalloped stent graft (PMSG) to extend the proximal landing zone in zone 2 have been reported in small case series with promising results. 6 Enlargement of the physician modified scallop to include one, two, or three supra-aortic trunks could provide an endovascular alternative to transposition for emergency cases with either a short proximal zone 3 neck or in specific cases with aortic arch injuries located on the inner circumference of the aortic arch.…”