Early experience and technical aspects of physician-modified fenestration in thoracic endovascular aortic repair for aortic arch pathologies

Abstract

Objective This study was performed to describe the treatment of aortic arch pathologies with a physician-modified fenestration (PMF) technique in thoracic endovascular aortic repair (TEVAR). Methods From August 2015 to August 2017, 32 patients with aortic arch pathologies underwent TEVAR with the PMF technique. All patients’ clinical data were analyzed with GraphPad Prism 7.0. Results Thirty-four aortic stent-grafts were implanted in 32 patients. The mean proximal diameter of the stent-graft was 32.4 ± 3.4 cm, and the mean length was 170.0 ± 25.2 cm. Twenty-nine PMF procedures were performed to preserve the left subclavian artery (LSA) and three to preserve both the LSA and left common carotid artery. The mean distance between the pathology and LSA was 8.4 ± 4.0 mm. The mean procedure time (from first to last digital subtraction angiography) was 22.8 ± 20.8 min. The mean follow-up time was 8.3 ± 5.3 months. During follow-up, the all-cause survival rate was 83.3% and the patency rate of the branch artery after PMF was 96.0%. Conclusion The PMF technique is a relatively safe, feasible, and time-saving method to preserve the branch artery in TEVAR for aortic arch pathologies. The short- to middle-term result of this technique is satisfactory.

A technical note and report of two patients with acute aortic syndrome who were treated with the new generation Ankura thoracic stent graft

“…The endograft has been also tested in more complex cases, with TEVAR and physician-modified technique to reconstruct the supra-aortic branches and showed satisfactory short-to middle-term results. 7 We expanded the use of Ankura Thoracic Stent Graft (Lifetech) for the treatment of acute aortic cases. In this case series, we presented our experience with the use of the new generation Ankura Thoracic Stent Graft (Lifetech).…”

Midterm Results of Retrograde In Situ Needle Fenestration During Thoracic Endovascular Aortic Repair of Aortic Arch Pathologies

“…PMSGF has major challenges in design, modification, and orientation and requires experienced physicians to execute it successfully. 16 Remote access via a tortuous delivery path, from the femoral artery through the abdominal and descending aorta, often means difficulties in orientation and precise fenestration alignment with supra-aortic vessels. Hence, using larger-sized fenestrations compared with the aortic branches is the common way to efficiently and accurately align the fenestration with the aortic branches.…”

“…For 21 patients with the LCCA (n=19) and IA (n=2) in the landing zone, the PMSGF technique was used as previously described 16 to modify an unsheathed stent-graft on a back table. These fenestrations were typically 0 to 10 mm larger in diameter than the target vessels.…”

Early and Midterm Outcome of TEVAR for Thoracic Aortic Pseudoaneurysm

“…Physician-modi ed fenestration (PMF) technique was selected to preserve LSA when the distance from TAP to LSA was < 15 mm, the neck length of the TAP was < 15 mm and the diameter was > 5.5 cm or rapid aortic growth had occurred (> 1 cm/year). The detailed process of PMF technique was same as before (15). Generally, the outer sheath of the stent was moved 3-4cm backward to expose the stent, a scalpel and scissor were used to remove the member of pre-fenestration area, and then using a belt to constrain the stent to return the outer sheath to the original position.…”