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We report the case of a 76-year-old man who developed type IA endoleak through the fenestration after 1-debranch TEVAR using a Najuta endograft. The patient was admitted with expansion of the aneurysm after TEVAR, for additional therapy. Type IA endoleak through a fenestration has remained a significant clinical concern and its treatment is challenging. We performed Zone 0 TEVAR using the “Squid-Capture” technique assisted in situ stent-graft fenestration. Cerebral vessels were perfused by a percutaneous cardiopulmonary support system during in situ stent-graft fenestration, and the cerebral branch was clamped at the proximal site. It is difficult to operate the catheter inside the endoskeleton structure of a Najuta endograft, but several innovations were effective. Test dilation of the balloon catheter was performed to ensure that the wire did not interfere with the endoskeleton. Avoiding interference with the endoskeleton is important. The Squid-Capture technique allows safe and secure puncture of the graft. The operation was completed successfully. After this procedure, the endoleak disappeared. It is considered to be a useful method for treatment of endoleak through the fenestration.
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Objective:To investigate the effect of different ways of reconstruction of left subclavian artery (LSA) in the treatment of complex aortic arch lesions.Methods:The clinical data of 34 patients with complex thoracic aortic disease undergoing intracavitary LSA reconstruction in our center from January 2019 to February 2020 were retrospectively analyzed. The distance of proximal healthy landing zone of all patients, including 29 aortic dissections involving LSA, 3 penetrating aortic ulcer and 2 thoracic aortic aneurysms, was less than 15 mm. Among them, 16 cases were treated with chimney technique, 16 cases were implanted with single branched stent-graft, 2 cases were received with left common carotid artery and LSA in situ fenestration.Results:The operation success rate of all 34 patients was 100%. One case was changed from in situ fenestration to chimney stenting. Followed up for 1-12 months, there were no death, cerebral ischemia, paraplegia and other postoperative complications. CTA review showed that the main and branch stents were in good shape, the patency rate of LSA branch stents was 100% and no endoleak occurred at 1 and 3 months after operation. The muscle strength and arterial blood pressure of bilateral upper limbs of all patients were basically the same.Conclusion:There is no consensus for the treatment of complex aortic arch lesions, so we need to customize the personalized plan and select the appropriate LSA reconstruction method in order to reduce the incidence of complications.
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@#Objective To report a simple and safe method for in situ fenestration of left subclavian artery in thoracic endovascular aortic repair (TEVAR). Methods Twenty-eight patients received in situ fenestration of left subclavian artery in TEVAR from June 2018 to May 2019 in our center, including 23 males and 5 females at an average age of 57.7±9.6 years. Among them, 12 patients used adjustable sheath or guiding catheter (a group A) and 16 patients used "J. D" technique (a group B). The clinical efficacy of the two groups was compared. Results In the group A, 1 patient failed to receive fenestration and was transferred to the chimney technique. In the group B, 1 patient due to the traction system shift during operation, was completed by traditional adjustable sheath puncture. The group B had shorter alignment-perforation time and trigger time and less complications. There was no significant difference in endoleak during short-term follow-up between the two groups. Conclusion The "J. D" technique is simple, safe and easy to obtain materials. It effectively reduces the risk caused by difficult sheath alignment during the in situ fenestration of the left subclavian artery. Although the results of recent follow-up are not significantly different from traditional methods, it still needs to accumulate the cases to observe the possible risks and difficulties.
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Objective To evaluate the short-term clinical effectiveness and feasibility of thoracic endovascular aortic repair(TEVAR) with in situ laser fenestration.Methods 24 patients who received TEVAR and in situ laser fenestration from January 2017 to March 2017 were retrospectively reviewed.Include 24 patients,19 males,5 females,with an average age of (54.00 ± 13.58) years old.The clinical data,including post-operative symptoms,hospitalization days,the success rate,postoperative complications,30-day fatality ratio,the patency rate of branch stents,endoleak,etc.Results The mean hospitalization time was(12.81 ±4.18) days.32 aortic arch branch vessels were treated using in situ laser fenestration,30 succeed in laser fenestration,surgical success rate was 93.8％.One case with postoperative paraplegia recovered after treatment,another one with the left common carotid incision hematoma recovered too.The incidence of operation-related complications was 8.3 ％.After the surgery 1 patient died,30-day fatality ratio of 4.2％.Imaging surveillance with computed tomography angiography(CTA) was performed one month later after the operation,the patency rate of branch stents was 100％,one case was found endoleak.Conclusion For revascularizating aortic arch branch vessels during TEVAR,in situ laser fenestration has an excellent successful rate and short-term curative effect,while the long-term surveillance is needed.
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Objective To evaluate the efficacy and safety of holmium laser in situ fenestration for aortic arch diseases during thoracic endovascular repair.Methods The clinical data of 12 patients with aortic dissection or aortic pseudoaneurysm was analyzed from Nov 2016 to Feb 2017.After thoracic aorta stenting the left common carotid artery and left subclavian artery were reconstructed using holmium laser in situ fenestration.Results The success rate of operation was 100％,no type Ⅰ or type Ⅱ endoleak occurred,1 case complicated with left retinal artery occlusion.All patients were followed up for 6 to 9 months,the mean time was 7.3 months.The location of the stent graft was good.The left carotid artery and left subclavian artery kept patent.Conclusions The laser in situ fenestration technique can provide the opportunity of stenting for patients with aortic arch lesion near the branch.Short term follow-up results were satisfactory.
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Objective To evaluate midterm outcomes of thoracic endovascular aortic repair (TEVAR) with in situ fenestration (ISF) to revascularize the aortic arch vessels.Methods From Feb 2012 to Dec 2014,10 patients underwent TEVAR with aortic arch vessels revascularized via ISF.There were 6 patients of thoracic aortic aneurysms (TAA) and 4 of type B aortic dissection (TBAD).Patients were followed for all-cause mortality,endoleak of post-TEVAR,integrity and patency of aortic endograft and branch vessels.Results Totally 11 branch vessels [10 left subclavian arteries (LSA),1 left common carotid artery (LCA)] via ISF were revascularized in 10 patients.Patients were followed-up for 24-55 mouths,mean of 42.80 months.1 TAA patient died in 2 years post-TEVAR unrelated to the operation.All fenestrations remained patent,and there were no endoleaks and no occlusion,compression,or fracture of stents.There were no postoperative strokes and left upper limbs ischemia.1 patient had distal aortic endograft pseudoaneurysms formation in 2 years post-TEVAR and underwent reTEVAR treatment.Conclusion Aortic arch vessels revascularization via ISF in TEVAR is safe and feasible.Midterm outcomes is satisfactory.
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Objective To evaluate a self-designed in-situ fenestration system to preserve left subclavian artery during thoracic endovascular aortic repair (TEVAR).Methods From June 2016 to May 2017,aortic dilatation disease patients with insufficient proximal landing zone were treated by the selfdesigned in situ fenestration system to preserve the left subclavian artery during TEVAR.The patients were regularly followed-up with CTA.Results Totally 12 patients with an average age of 65 ± 11 years were enrolled.Among them,6 patients had thoracic aortic aneurysm and the other 6 suffered from aortic dissection.The mean operating time was 145 ± 36 minutes.The perioperative procedure success rate was 100％.One patient had intraoperative type Ⅰ endoleak,1 patient had type Ⅱ endoleak.One patient had suffered from stroke and 1 patient had mild paraplegia post-operatively.All patients were followed-up for a mean time of 6.5 ± 3.0 months.The type Ⅰ endoleak in 1 patient disappeared,type Ⅱ endoleak remained in one.There was no death during perioperative and in follow up period.Conclusions This self-designed in-situ fenestration system effectively and quickly restores the blood flow of the left subclavian artery during TEVAR.
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Objective To evaluate the application value of diode laser in situ fenestration in the thoracic endovascular aortic repair (TEVAR) for the treatment of aortic arch disease.Methods The retrospective crosssectional study was conducted.The clinical data of 110 patients with aortic arch disease who underwent TEVAR using diode laser in situ fenestration in the Ninth People's Hospital of Shanghai Jiaotong University School of Medicine from January 2014 to June 2017 were collected.TEVAR using diode laser in situ fenestration was performed according to the lesion involving the three branches of aortic arch.Observation indicators:(1) surgical and intraoperative situations;(2) follow-up.All patients were followed up by outpatient examination,inpatient examination and telephone interview up to May 2017.CT angiography was performed to evaluate the patency of the stents and presence of endoleak at 3,6,and 12 months postoperatively.Measurement data with normal distribution were represented as x ±s.Results (1) Surgical and intraoperative situations:106 of 110 patients underwent successful TEVAR using diode laser in situ fenestration.Intraoperative digital subtraction angiography (DSA) showed that primary aortic dissection incisions were completely closed,with a patency of all stents and no fenestration-related endoleaks.The surgical success rate was 96.36％ (106/110).Two patients died of intraoperative pericardial tamponade and 2 received chimney stent implantation after complex anatomic configuration of the aortic arch inducing to failure of the innominate artery fenestration.Of 106 patients,70 received left subclavian arterial fenestration,30 received 3 aortic branches fenestration and 6 received both left subclavian arterial and left common carotid arterial fenestrations.The operation time and dose of contrast agent in 110 patients were respectively (140±9)minutes and (185±-5)mL.Four patients had postoperative complications,1 died of severe pulmonary infection and 3 with cerebral infarction were improved by anti-platelet,brain nerve nutrition and other symptomnatic treatment.Other patients had no transient ischemic attack,stroke,brain infarction,myocardial infarction or other neurological complications.Duration of hospital stay of the 110 patients was (15 ± 7)days.(2) Follow-up:99 of 107 patients were followed up for 2-17 months,with a median time of 10 months.During the follow-up,there were patencies of all stents,and endoleaks of 4 patients occurred and were closely followed up and observed.Conclusion The diode laser in situ fenestration is safe and feasible in the TEVAR for the treatment of aortic arch disease,with satisfactory short-term outcomes.