A Systematic Review of Contemporary Outcomes from Aortic Arch In Situ Laser Fenestration During Thoracic Endovascular Aortic Repair

Systematic Review on In Situ Laser Fenestrated Repair for the Endovascular Management of Aortic Arch Pathologies

“…Data arising mainly from fenestrated and branched arch repair showed a stroke risk rate up to 15% earlier in the literature, while increasing experience achieved a decrease in the potential cerebrovascular complication rate [ 28 , 29 ]. In this analysis, the stroke rate was 5% and within the reported limits in the literature for endovascular arch repair, while recent data on hybrid repair, using SAT debranching, reported a stroke rate up to 14% [ 18 , 28 , 29 , 30 , 31 ]. Anatomic factors, as shaggy or heavily calcified aorta as well as the role of medical treatment using single or double antiplatelet therapy, could not be investigated in the current analysis, despite their potentially significant role in stroke prevention, and need further assessment.…”

Left carotid chimney and left subclavian artery laser fenestration for zone 1 thoracic endovascular aortic repair

“… 9 More recently, a systematic review of contemporary outcomes from aortic arch in situ laser fenestration during TEVAR evaluated 440 patients between 2013 and 2021. 10 The mean follow-up duration was 12.5 months, and the main indication for treatment was aortic dissection. Single fenestrations were the most common (68%), followed by triple (22%) and double (9%) fenestrations.…”

“…Branch patency was excellent at 97%, and endoleaks occurred in 4.8%, stroke in 2%, and spinal cord ischemia in 0.2%. 10 Retrograde dissection was observed in 0.9%, and the 30-day mortality was 2%, with the investigators concluding that in situ laser fenestration is a feasible, safe, and effective approach to treat aortic arch disease in patients unsuitable for open or custom-made endovascular methods. 10 Challenges to the retrograde approach for the arch include ensuring an approximately perpendicular approach of the laser fiber either to the target artery orifice (in an antegrade laser fenestration) or retrograde to the graft fabric from the target artery (eg, arch vessels).…”

Endovascular Strategies for Aortic Arch When US Food and Drug Administration–Approved Devices Are Not Available

“…A systematic review of 8 studies and 440 patients presented 299 patients (68%) with a single fenestration, 40 patients (9%) with a double fenestration, and 97 patients (22%) with a triple fenestration; the study demonstrated a 30-day mortality rate of 2%, a 2% rate of stroke, and a 4.8% rate of endoleak. 9 In a similar analysis of 6 retrospective studies with a total of 247 patients, 59 patients (23.9%) presented with aortic arch aneurysms, and 146 patients (59.1%) presented with dissections; the technical success rate was 98%. There were 11 cases of stroke within 30 days; 13 reinterventions (5.3%); and 10 patient deaths (4.2%), of which 1 was related to an aortic complication.…”