Author + information
- Zhi Zheng,
- Chun Liu,
- Qiannan Guo,
- Fubin Liu,
- Yanbo Dong,
- Haihao Wang and
- Youmin Pan
Thoracic endovascular aortic repair (TEVAR) alone is insufficient to treat lesions involving distal arch or even ascending aorta. Instead of using a custom-made fenestrated endograft, we made an “on-the-spot” fenestration on the graft before we insert the stent in hybrid operating room. It was called physician-modified fenestrated endograft. This study is to evaluate early results of endovascular repair for aortic pathology involving distal arch or ascending aorta with physician-modified fenestrated endografts.
A total of 61 patients with aortic pathology involving distal arch or ascending aorta who underwent endovascular repair with physician-modified fenestrated endografts in a hybrid operating room between January 2013 and December 2014 were analyzed. Among these patients (45 male, 16 female), Stanford type B aortic dissections accounted for the lesions in 51 patients (46 acute and 5 chronic cases), 6 patients showed penetrating aortic ulcer of the ascending aorta with intramural hematoma, 3 patients showed descending thoracic aortic aneurysms, and 1 patient showed compound lesions involving the descending thoracic aortic dissection as well as penetrating aortic ulcer located at the lesser curvature of the aortic arch. Preoperative computerized tomographic angiographic (CTA) examinations for the thoracoabdominal aorta revealed that 35 patients had lesions adjacent to or involving the left subclavian artery (LSCA), 20 patients had lesions adjacent to or involving the left common carotid artery (LCCA) and LSCA, and 6 patients had lesions involving the ascending aorta.
All procedures were technically successful. In total, fenestration for LSCA was made in 35 cases; fenestration for LCCA in 5; fenestration for LCCA plus LSCA in 15; and fenestration for RBCA plus LCCA as well as LSCA in 6. There was one case (1.6%) of in-hospital mortality due to progression of aortic dissection. No stroke or spinal injury or other complications were reported during perioperative period. Overall hospitalization time was (10±4) d. Follow-up CTA results at 3, 6, and 12 months postoperatively showed no endoleak and preservation of neck blood flow with fenestration. TEVAR with physician-modified fenestrated endografts resulted in complete thrombosis of the false lumen, reabsorption of the false lumen thrombus, and enlargement of the true lumen. No death or relevant aortic event was reported during the 1-year follow-up period.
Endovascular repair for aortic pathology involving distal arch or ascending aorta with physician-modified fenestrated endografts is an easy handling technique, which is minimally invasive and ensures speedy patient recovery; however, further large-scale follow-up studies are required to verify its long-term efficacy.