Outcomes of Total Endovascular Aortic Arch Repair with Surgeon-Modified Fenestrated Stent-Grafts on Zone 0 Landing for Aortic Arch Pathologies

Abstract

Objectives This study evaluated the feasibility and safety of total endovascular aortic arch repair with surgeon-modified fenestrated stent-graft on zone 0 landing for aortic arch pathologies. Methods Between June 2016 and October 2019, 37 consecutive patients underwent total endovascular arch repair with surgeon-modified fenestrated stent-grafts on zone 0 landing. Outcomes included technical success, perioperative and follow-up morbidity and mortality, and branch artery patency. Results During the study period, 37 patients were treated with total endovascular aortic arch repair with surgeon-modified fenestrated stent-graft. Twenty-one (56.8%) patients were diagnosed with aortic dissections, 15 (40.5%) patients with aneurysms, and 1 (2.7%) patient required reintervention due to endoleak and sac expansion from previous thoracic endovascular aortic repair for thoracoabdominal aneurysm. The proximal landing zone for all patients were in zone 0, and all branch arteries of aortic arch were reconstructed. Technical success was achieved in 34 cases (91.9%). Three (8.1%) patients had fenestrations misaligned with target arteries, and the chimney technique was applied as a complementary measure. Thirty-day mortality rate was 5.4% (n=2). Thirty-day stroke rate was 5.4% (n=2). Thirty-day reintervention rate was 2.7% (n=1). At a median follow-up of 20 months (range, 3–49 months), 5 (13.5%) patients died, including 2 aortic-related deaths, 1 nonaortic-related death, and 2 deaths of unknown reason. One (2.7%) patient had stroke. Four patients (10.8%) had reintervention during the follow-up, including 2 cases of left subclavian artery occlusion and 2 cases of type II endoleak. The estimated survival (±SE) at 2 years was 72.4%±9.7% (95% CI 53.4%–91.4%). The estimated freedom from reintervention (±SE) at 2 years was 87.4%±5.9% (95% CI 75.84%–98.96%). Conclusions Total endovascular aortic arch repair with surgeon-modified fenestrated stent-grafts on zone 0 landing is an alternate option for the treatment of aortic arch pathologies in experienced centers.

Outcomes of Zone 1 Thoracic Endovascular Aortic Repair With Fenestrated Surgeon-Modified Stent-Graft for Aortic Arch Pathologies

“…In our previous experience, only 3 cases (2.7%) of stent-graft migration and no stent fractures were identified during a 49.5 ± 18.3 months follow-up period. 14 In this series, no stent-graft migration and fracture were identified during a median follow-up of 48 months (range, 12–68 months). Nonetheless, stent-graft migration and fracture are related to severe complications and poor outcomes; thus, patients treated with fenestrated SMSGs must be under close and strict imaging surveillance in case of any potential stent-graft fracture and migration.…”

Outcomes of thoracic endovascular aortic repair with fenestrated surgeon-modified stent-graft for type B aortic dissections involving the aortic arch

“…Revascularization of supra-aortic trunks with minimal cerebral hypoperfusion time is essential for a successful treatment, including LSA, reconstruction of which had gone through controversies, while currently there is an agreement for the necessity of its reconstruction (10). Different endovascular techniques had been used in the revascularization of supraaortic trunks, including the chimney technique, custom-made branched stent-graft, in situ fenestration, and f-SMSG (11)(12)(13)(14). Chimney technique was related to a higher incidence of type Ia endoleak owing to the gutter.…”

Experience with the Ankura Thoracic Stent Graft and In-situ Fenestration for the Left Subclavian Artery with the Fu-Through Needle - a Technical Overview and Comparison to Similar Endovascular Techniques

“…When LSA revascularization is required during TEVAR, carotid-subclavian bypass and fenestrated TEVAR (F-TEVAR) are both safe and effective methods. F-TEVAR appears to offer equivalent clinical outcomes as a less time-consuming and minimally invasive alternative [4,5,6].…”

“…Another possible drawback of the technique is the difficulty of deploying the graft exactly at the level of the target vessel orifice. A non-correct deployment could lead to an impossible cannulation of the fenestration or to a misplacement and kinking of the bridging stent, resulting in stenosis, occlusion, or endoleak [6,7].…”