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• W2996604828 abstract "Introduction - Left subclavian artery (LSA) revascularization is required due to inadequate proximal landing zone during thoracic endovascular aortic repair (TEVAR) in high-risk patients of proximal descending aortic pathologies and distal arch pathology. The aim of this study was to evaluate perioperative and short-term outcomes of different patterns of fenestration for LSA revascularization in single center. Methods -From January 2017 to December 2017, 59 patients (38 men and 21 women; 57±17 years; range, 36–79 years; acute type B aortic dissection in 27 patients, penetrating aortic ulcer in 29 patients and thoracic aortic aneurysm in 3 patients) who received LSA revascularization by fenestration during TEVAR were included, patients who received innominate artery and left common carotid artery revascularization (including chimney, fenestration, debranching), or with aberrant subclavian artery/left vertebral artery were excluded in this retrospective study. Among them, in situ fenestration (ISF) was achieved with balloon-assisted puncture needle, followed by covered stent insertion via fenestration; physician-modified fenestration (PMF) was performed with cautery pen in vitro on partial deployed stent-graft, with or without target vessel stenting via fenestration after deployment. Computed tomography surveillance was performed at one-month, six-month and yearly after procedure. Perioperative and follow-up outcomes, procedure-related complications of these two groups were compared. Results - 10 patients were included in ISF group and 49 patients in PMF group, the distribution of types of pathologies did not differ between two groups, whereas 85.7%(42/49) pathologies located in lesser curvature of arch in PMF group and 80%(8/10) in greater curvature of arch in ISF group. No 30-day mortality in both two groups. The technical success of LSA revascularization was achieved in 95.9%(47/49) of PMF and all patients of ISF group, respectively. Misalignment of fenestration and orifice of LSA occurred in two cases of PMF group, and thereafter, received bailout chimney stent insertion through branchial artery. The operative time in ISF group was 103.3±57.9 minutes vs. 67.9±34.0 minutes in PMF group (P=.03), the contrast medium use was 82.8±30.4ml in ISF group vs. 75.6±15.4ml in PMF group(P=.08). Eight patients of PMF group received target vessel stenting because of contrast delayed in LSA after aortic stent-graft deployment. Completion angiogram of PMF group showed higher incident rate of endoleak than ISF group (5/49 vs. 1/10, P=.007), one patient in PMF group suffered from retrograde dissection which underwent aortic arch and ascending aortic replacement. During post-operative follow-up (8.5±3.6 months, [4-15]), all target vessels were patent in ISF group while patency rate of LSA in PMF was 91.8%(45/49), one case of ischemic stroke occurred in PMF group. Conclusion - Fenestration technique is effective and safe for LSA reconstruction during thoracic endovascular aortic repair. In situ fenestration and physician-modified fenestration have similar short-term results, while the incident rate of endoleak in situ fenestration group is lower. Long-term follow-up and larger sample size researches are needed to investigate the outcomes of the two methods." @default.
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• W2996604828 date "2019-12-01" @default.
• W2996604828 modified "2023-10-18" @default.
• W2996604828 title "Comparison of In Situ Fenestration and Physician-modified Fenestration for Left Subclavian Artery Revascularization During Thoracic Endovascular Aortic Repair" @default.
• W2996604828 doi "https://doi.org/10.1016/j.ejvs.2019.06.813" @default.
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