Long-Term Results of Endovascular Repair for Distal Arch and Descending Thoracic Aortic Aneurysms Treated by Custom-Made Endografts: Usefulness of Fenestrated Endografts

Abstract

Early results of custom-made endografts were excellent, and fenestrated endografts were safe for distal arch and proximal descending aortic aneurysms.

Minimally Invasive Techniques for Total Aortic Arch Reconstruction

“…20 Excellent results with custom-made fenestrated devices have been reported. [21][22][23] The Japanese Najuta fenestrated thoracic stent graft (Kawasumi Laboratories, Tokyo, Japan) uses a combination of preformed stainless steel stents, externally attached PTFE, and curved delivery sheaths for total endovascular aortic arch reconstruction. In a study of the first-generation thoracic stent graft in more than 380 patients, technical success was achieved in 95.8% of patients, with a perioperative mortality rate of 1.6%, paraplegia rate of 0.8%, and CVA rate of 1.8%.…”

“…However, long-term branch vessel patency and late endoleak remain a concern. 21 Retrograde access to the supra-aortic branches by means of downstream vascular puncture allows in situ fenestration of conventional thoracic aortic grafts. A variety of techniques have been used to puncture the fabric of the TEVAR device, sequentially dilate the fenestration with balloons, and seal the fenestration with a covered stent graft.…”