Physician-modified fenestration or in situ fenestration for preservation of isolated left vertebral artery in thoracic endovascular aortic repair

Abstract

ObjectiveTo present our experience of preserving the isolated left vertebral artery (ILVA) with physician-modified fenestration (PM-F) or in situ fenestration (ISF) during thoracic endovascular aortic repair (TEVAR) for aortic pathologies involving aortic arch.MethodsThis is a single-center, retrospective, observational cohort study. Between June 2016 and December 2021, 9 patients (8 men; median age 60.0 years old) underwent TEVAR with ILVA reconstruction (PM-F, n = 6; ISF, n = 3) were identified and analyzed.ResultsThe technical success rate was 100%. No early (<30 days) death occurred. No aortic rupture, major stroke or spinal cord injury was observed. The median follow up was 38.0 (rang: 1.0–66.0) months. One death occurred at 56 months, while the reason cannot be identified. No aortic rupture, major stroke or spinal cord injury was observed during follow up. No patient required reintervention. Out of the 22 successfully revascularized target vessels, 2 ILVAs were found occluded in 2 patients at 6 months and 7 months, respectively. However, these two patients were asymptomatic.ConclusionsOur initial experience reveals that PM-F or ISF for ILVA preservation was feasible, safe, and effective during TEVAR for complex thoracic aortic pathologies. However, the patency of preserved ILVA should be improved.

Utilizing physician modified fenestration on the castor branched stent technique for reconstruction of an isolated left vertebral artery on the aortic arch

“…Recently, the reported in-situ fenestration (ISF) and physician modified fenestration (PMF) techniques on conventional unbranched stents were suggested as an approach to manage ILVA, suggesting possible substitutes with promising short-term outcomes 9 . Nevertheless, the potential for a stent or PMF migration remains a notable concern 18 .…”

“…Major adverse events (MAEs) were composed of aortic-related mortality, aortic rupture, stroke, spinal cord injury, puncture site infection, myocardial infarction, severe pneumonia, acute kidney injury and other severe sequelae. Patency was determined to be a target of fifty percent or less vascular stenosis 9 .…”

“…The application of ILVA transposition has shown positive outcomes 8 . Improved safety and less invasiveness are benefits of total endovascular repair of ILVA using physician modified fenestration (PMF) or in situ fenestration (ISF) on the conventional stent 9 . However, we believe that there is still room for improvement in these two approaches.…”