ABSTRACT
Objective:To evaluate the feasiblity and safety of in situ fenestration during the endograft of thoracic endovascular aortic repair (TEVAR) via the left subclavian artery (LSA).Methods:A total of 23 patients, including 17 patients with thoracic aortic dissection and 6 patients with thoracic aortic aneurysm, were respectively enrolled from October 2018 to June 2019 at Nanfang Hospital, Southern Medical University. All of the patients underwent in situ fenestration of LSA via the thoracic artery endograft following the TEVAR procedure. A 21 G preflex hollow needle was used to puncture the endograft from the medial segment of LSA for in situ feneatration. The success rate, clinical effect and complications were recorded on 1, 3 and 6 months after in situ fenestration.Results:The success rate was 100% in all the 23 patients with needle puncture in situ fenestration of LSA. The rechecked thoracic aorta angiography showed that both thoracic aortic main endograft and the LSA branch cover stent were well expanded, and there were no endoleaks occurred around the LSA branch cover stent. No hematoma was found in the supraclacicular fossa within all the perioperative period. A small pneumatothorax in the left pleural cavity which did not need treatment was being detected in 1 patient on the chest film 3 days after the procedure. The mean follow-uptime was (4.2±1.4) months. There were no retrograde tearing happened in the proximal end of the endograft, and no endoleak happened around the LSA branch cover stent either.Conclusion:The technique of needle puncture fenestration of LSA via the thoracic artery endograft is considered as a simple, safe, and effective method of in situ LSA reconstruction.
ABSTRACT
Objective To investigate the clinical applications of sandwich technique according to area calculation in endovascular aneurysm repair of patients with aorta and iliac artery lesions.Methods Six patients with aortoiliac artery disease confirmed by CT were treated using sandwich technique according to area calculation.The diameter of the main stent and two branches stents were chosen according to the area calculation.Technical success rate,patency of the stent graft and complications were observed.Results Technical success rate was 100％ (6/6),and no complications occurred in all the 6 patients.The clinical symptoms were significantly improved.Gutter endoleak was found in 1 patient 2 months after the procedure,and was managed by coil embolization successfully.No endoleak occurred in other patients during follow-up of 6-31 months.Conclusion For patients with special anatomy of aorta and iliac artery lesions,the application of area calculation in the sandwich technique provides a feasible approach in choosing the matching size of the main body stent and two side branches stents.