Hybrid versus in vitro fenestration for preserving the left subclavian artery in patients undergoing thoracic endovascular aortic repair with unfavorable proximal landing zone

Abstract

Purpose To compare hybrid and in vitro fenestration procedures for preserving the left subclavian artery in thoracic endovascular aortic repair (TEVAR) with unfavorable proximal landing zone. Methods Retrospective comparison of data from 49 consecutive patients who underwent left subclavian artery revascularization during TEVAR by either hybrid or fenestration approaches from January 2015 to March 2018. Procedural duration, and 30-day rates of procedural success, mortality and complications (endoleaks, cerebral infarction, spinal cord ischemia, left arm ischemic symptoms, and delirium) were compared. Results For hybrid procedure ( n = 32) vs. fenestration ( n = 17) groups, which were age and gender matched: procedural success rate was 100%, with significantly longer procedural duration (248.4 ± 40.9 vs. 60.6 ± 16.8 min; t = –22.653, P = 0.000) and similar 30-day complication rate (18.8% vs. 11.8%; χ2 = 0.397, P = 0.529). At 12.7 ± 9.3 months’ follow-up, there were no cases of death, spinal cord ischemia, or other complications in either group. Conclusions In this retrospective, single-center comparison, both hybrid and in vitro fenestration approaches for reconstructing the left subclavian artery in TEVAR with unfavorable proximal landing zone appeared safe and effective, with shorter procedural duration for fenestration. Larger studies with longer term follow-up are warranted.

Comparison of techniques for left subclavian artery preservation during thoracic endovascular aortic repair: A systematic review and single-arm meta-analysis of both endovascular and surgical revascularization

“…There are two types of fenestration techniques, pre-fenestration and in situ fenestration, each of which may be appropriate in certain clinical situations. In the current meta-analysis, all the cases in other studies except two were totally complemented in situ fenestration technique ( 26 , 46 ). An increasing number of studies have described the high repeatability and low perioperative mortality and morbidity of this procedure ( 25 , 57 , 58 ).…”

Application of left common carotid-left subclavian artery shunt for reconstruction of left subclavian artery in TEVAR of type B aortic dissection with insufficient proximal anchoring area: 10 years of single-center experience

“…Therefore, surgical intervention should be performed cautiously to reduce nerve damage, excessive tension, and destruction of the entire wound. However, a shunt also has its advantages, which not only avoids the serious complications caused by conventional cryopreservation, large thoracotomy, and massive blood transfusion, but also compensates for the shortcomings of TEVAR surgery in treating complex arch lesions, enlarges the anchoring area of TBAD, and thus expands the indications for TEVAR [5] .…”

“…We included 63 patients based on the inclusion and exclusion criteria [5] ; their characteristics are listed in Table 1. The mean age at onset was 52.3 ±11.6 years, and men were 54 (86.2 %).…”

Mid-term Outcomes of Endovascular and Hybrid Procedures to Treat Complex Aortic Arch Pathologies

“…Depending on the extent of lesion involvement, the aortic arch can be "debranched" 10 through the chimney technology, branch stent technology, in situ fenestration technology, and prefenestration technology, which can help release the stent at a more proximal position so that the endovascular technology can be applied more widely. 11,12 The hybrid surgery also proves to be highly effective for some complex pathologies of the aorta, and can minimize the incidence of complications and the risk of death. 13 The procedure combines transposition of supra-aortic vessels with endovascular surgery.…”