A Single Center Experience Of In Situ Needle Fenestration Of Supra-aortic Branches During Thoracic Endovascular Aortic Repair

Purpose:To evaluate the safety and efficacy of in situ needle fenestration during thoracic endovascular aortic repair(TEVAR)and report the single-center experience.Materials and Methods:170 patients with thoracic aortic disease who underwent TEVAR with in situ needle fenestration in our department between February 2016 and Dec 2018 were included in this study.Their demographic information,clinical manifestations,periprocedural outcomes,and follow-up results were analyzed.Results:In total,97.6%of attempted fenestrations were successful(166/170).Fenestration of the left subclavian artery(LSA)was performed in 121 patients,fenestration of either the LSA or brachiocephalic trunk(BCT)plus the left common carotid artery(LCCA)was performed in 25 patients,and fenestration of the three supra-aortic branches was performed in 20 patients.External iliac artery rupture occurred in one case.Cerebrovascular events occurred in four cases and myocardial infarction occurred in one.Three death in perioperative period.One case had a branch stent graft stuck in the brachial artery.During a mean follow-up of 12.9 months,three patients developed retrograde type A dissection,and one was subsequently treated with a stent graft and BCT fenestration.One case presented with numbness in the fingertips of the left hand,and computed tomography angiography(CTA)indicated stenosis of the branch stent in the LSA.CTA examination revealed no endoleaks or expansion of the aortic aneurysms in any of the patients.Conclusions:In situ needle fenestration of endografts in the aortic arch is technically feasible,yielding acceptable short-term results in a selected patient cohort.Further studies are needed to determine mid-and long-term outcomes before more widespread adoption.