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

Abstract

Background: In situ laser-fenestrated thoracic aortic endovascular repair (FTEVAR) has emerged as a valuable alternative for aortic arch management. This review assessed the early and follow-up outcomes of in situ laser-FTEVAR in aortic arch pathologies. Methods: The PRISMA statement was followed. The English literature was searched, via Ovid, until 15 October 2022. Observational studies, published after 2000, reporting on early and follow-up outcomes for the in situ laser-FTEVAR were eligible. The Newcastle–Ottawa Scale was used to assess the risk of bias. Primary outcomes were the technical success, stroke, and mortality at 30-days, and the secondary were the mortality and reintervention during follow-up. Results: Six retrospective studies from 591 and 247 patients were included. Fifty-nine (23.9%) patients were managed for aortic arch aneurysms and 146 (59.1%) for dissections; 22.6% of them for type A. Technical success was at 98% (range 90–100%). Eight patients died (3.2%) and 11 cases presented any type of stroke (4.5%) during the 30-day follow-up. The mean follow-up was 15 months (1–40 months). Ten deaths were reported (4.2%); one was aortic-related (10%). Thirteen re-interventions (6.0%) were performed. Conclusions: In situ laser-FTEVAR for aortic arch repair may be performed with high technical success and low 30-day and midterm follow-up mortality, stroke, and re-intervention rates when applied in well selected patients and performed by experienced teams.

The safety and efficacy of left subclavian artery reconstruction through in situ needle fenestration in thoracic endovascular aortic repair

“…Some studies suggest that circular windows with intact edges allow for better adaptation to window branch brackets [36]. Laser and radiofrequency cauterization performed during membrane rupture may result in the formation of blood clots, thereby posing a potential risk of embolism, and the puncture needle utilizes the mechanical membrane disruption principle to create an opening, which is safer than the thermal effect of a laser or RF probe to open the window because of its capacity to avoid the risk of brain infarction caused by debris or thrombosis formation during the process of membrane breaking or prolonged intracavitary operation [13,22]. Luo et al demonstrated the safety and feasibility of acupuncture fenestration, which effectively reduced the incidence of perioperative complications [37].…”

“…Furthermore, in this study, one patient died to type A dissection caused by proximal reverse avulsion within 30 days, resulting in a 30-d mortality rate of 2.2%. During the follow-up period, there were 3 deaths (6.5%) attributed to nonaortic disease factors and 2 complications (4.3%) resulting from the puncture approach, both of which demonstrated lower incidence rates than those reported in relevant studies conducted domestically and internationally [3,13].…”

“…Fenestration is performed at the opening of the target blood vessel, and the branch stent is placed through the window to allow minimally invasive reconstruction of the branch blood vessel in the thoracic aorta without changing the patient's own blood ow channel [12,13]. McWilliams et al reported that the left subclavicular artery was reconstructed by using in situ fenestration technique during TEVAR [14].…”

Urgent endovascular mycotic aortic arch aneurysm repair using in situ laser fenestration and selective arterial perfusion with venoarterial extracorporeal membrane oxygenation

“…A recent systematic review of ISLF for the endovascular management of aortic arch pathologies showed a low stroke rate of 5%. 7 However, reports of ISLF so far consist of small single-center experiences, resulting in the possibility of selection and publication bias.…”

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

“…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. 10 …”