Homemade fenestrated stent-graft for thoracic endovascular aortic repair of zone 2 aortic lesions
Ludovic Canaud, Kiyofumi Morishita, Thomas Gandet, Julien Sfeir, Sebastien Bommart, Pierre Alric, Marcello Mandelli, Ludovic Canaud, Kiyofumi Morishita, Thomas Gandet, Julien Sfeir, Sebastien Bommart, Pierre Alric, Marcello Mandelli
Abstract
Objective: The aim of this retrospective analysis was to evaluate the outcomes of homemade fenestrated stent-grafts for thoracic endovascular aortic repair of zone 2 aortic lesions.
Methods: From November 2013 to January 2017, 24 patients underwent thoracic endovascular aortic repair with left subclavian artery revascularization using a homemade fenestrated stent-graft to preserve the patency of the left subclavian artery. Elective cases accounted for 54% (n = 13) of the sample. Indications included acute complicated type B aortic dissection (n = 9), degenerative aneurysm (n = 9), penetrating aortic ulcer (n = 5), and intramural hematoma (n = 1). Routine postoperative follow-up imaging with computed tomography angiography was performed to assess thoracic endovascular aortic repair and left subclavian artery fenestration patency and endoleak.
Results: Median duration for stent-graft modification was 16 minutes (range, 14-17 minutes). The technical success rate was 100%. One patient had a distal type I endoleak requiring additional stent-graft placement. One patient had partial coverage of the left common carotid artery requiring left common carotid artery stenting. One patient had a stroke without permanent sequelae (4.1%). Overall mortality was 0%. All left subclavian arteries were patent. Two type III endoleaks required additional left subclavian artery covered stent placement. One type II endoleak is currently observed. During a mean follow-up of 13.2 ± 2 months, there were no conversions to open surgical repair, aortic rupture, paraplegia, or retrograde dissection.
Conclusions: The use of a homemade fenestrated stent-graft for thoracic endovascular aortic repair of zone 2 aortic lesions is both feasible and effective for left subclavian artery revascularization during thoracic endovascular aortic repair involving a spectrum of thoracic aortic pathology. Durability concerns will need to be assessed in additional studies with long-term follow-up.
Keywords: physician-modified thoracic stent-grafts; thoracic endovascular aortic repair.
Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
Source: PubMed