| Background: Since the complete endovascular treatment of descending thoracic aortic disease was reported by Dake in 1994,with the continuous development of endovascular technology,thoracic endovascular aortic repair(TEVAR)has been widely used and has been the first choice for the treatment of Stanford B thoracic aortic dissection.Compared with traditional open surgery,endovascular repair has the advantages of less trauma,low mortality and low incidence of complications.The indications of complete endovascular repair of aortic are also expanding.However,for some complex thoracic aortic lesions involving the left subclavian artery and the Zone-0 of the aorta,the patency of supra-aortic branches is the difficulty of endovascular treatment at present.As one of the applicable techniques,fenestrated stent-graft was first reported in 1999 for the reconstruction of visceral branch arteries in endovascular repair of near-abdominal aortic aneurysm.Subsequently,pioneers in this field also optimized and further explored this technique,although after more than 20 years of technique and experience progress,complete endovascular repair of aortic arch is still in the stage of exploration and discussion.Objective: The purpose of this study was to report the preliminary single-center experience of TEVAR with fenestrated stent-graft in the treatment of aortic arch diseases with inappropriate proximal landing zone,and to evaluate its feasibility,safety and efficacy.Methods: The clinical data of 20 patients undergoing TEVAR with fenestrated stent-graft for aortic arch diseases with inappropriate proximal landing zone between February 2017 and May 2020 were retrospectively analyzed.Results:(1)Among the 20 patients in this study,the average age was 64 ±12 years old,and there were more males(70%).According to the preoperative CTA data,there were4 cases of thoracic aortic aneurysm,2 cases of thoracic aortic aneurysm with abdominal aortic aneurysm,1 case of thoracic aortic aneurysm with aortic dissection,6 cases of aortic intermural hematoma with penetrating ulcer,6 cases of aortic dissection,and 1case of type I leakage of proximal stent-graft after TEVAR.(2)The proximal landing zone of the stent-graft was located in Zone-0 in 5 cases(25%),Zone-1 in 8 cases(40%),and Zone-2 in 7 cases(35%).There were 12 cases(60%)of single fenestration,6 cases(30%)of double fenestration and 2 cases(10%)of triple fenestration.A total of 33 branches were remodeling,of which 10 branches were treated with branch stents.(3)The technical success rate was 100%(20/20),3 cases died within 30 days after operation(15%),2 cases had acute renal injury(10%)and 1 case had severe pneumonia(5%).There were no ischemic stroke,paraplegia,hemorrhage,ischemic stroke,puncture or incision-related complications.(4)The median follow-up time of survival patients was 31±12 months,and 2 cases lost follow-up.During the follow-up,2 cases died,the overall survival rate was 75%;the early re-intervention rate was 0%,and the mid-term re-intervention rate was 5%.Leakage was found in 3 cases(15%),and it was reduced in 2 cases.(5)In subgroup analysis,no differences in terms of 30-day mortality,overall mortality and re-intervention rate were observed between patients with landing in Zone-0 vs Zone-1 and Zone-2.And also no differences in terms of 30-day mortality,overall mortality and re-intervention rate were observed between patients with triple fenestration and patients with single and double fenestration.Conclusion: TEVAR with fenestrated stent-graft is a feasible and effective method with satisfied short-term results for the treatment of aortic arch diseases with inappropriate proximal landing zone,but there is a lack of large samples and long-term randomized controlled trials,so it should be flexibly compared or combined with other techniques in the treatment of this kind of aortic arch diseases. |
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