Article

An international multi-center application of self-radiopaque markers guiding physician-modified fenestration (S-fenestration) in endovascular repair of aortic arch pathologies

Chang ShuDepartment of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, ChinaXin LiDepartment of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, ChinaKun FangState Key Laboratory of Cardiovascular Diseases, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100037, ChinaMingyao LuoState Key Laboratory of Cardiovascular Diseases, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100037, ChinaQuanming LiDepartment of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, ChinaMing LiDepartment of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, ChinaHao HeDepartment of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, ChinaYuanyuan GuoFuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, ChinaLei ZhangDepartment of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, ChinaChenzi YangDepartment of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, ChinaTun WangDepartment of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, ChinaMo WangDepartment of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, ChinaLunchang WangDepartment of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, ChinaJiehua LiDepartment of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, ChinaDing xiao LiuDepartment of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, ChinaJosé Fernando TeixeiraHospital São João Porto Portugal, PortugalSuko AdiartoNational Cardiovascular Center Harapan Kita Hospital, IndonesiaTao FanRepublican Specialized Center of Surgery Named After Academician V.Vakhidov, UzbekistanMakhkamov NajmiddinRepublican Specialized Center of Surgery Named After Academician V.Vakhidov, UzbekistanPavel Charnahlaz1st City Clinic Minsk, Balerussia, UKGiorgi Kheladze

Asian Journal of Surgeryjournal2025en

ABI

Abstract

Thoracic endovascular aortic repair (TEVAR) has currently become the “first-line choice” for the repair of various descending aorta pathologies. However, for aortic arch pathologies, physician-modified fenestration TEVAR is an alternative method that is capable of dealing with some of the anatomic difficulties in this special case. In this article we introduce a well-established technique that uses a radiopaque marker in the stent graft, self-radiopaque physician-modified fenestration (SF). We analyzed a cohort of retrospective and follow-up data from 7 hospitals all over the world for patients who underwent SF-TEVAR. To our knowledge, this study holds the largest group size ever around the worldi. The data of 658 patients who underwent SF TEVAR from 6 different countries and 7 hospitals from December 2015 to May 2023 were retrospectively analyzed. Information regarding procedure time, contrast dose stent graft, and bridging stent was collected for analysis, and follow-up results were recorded at 1 month, 6 months, 12 months after the procedure, analyzed the survival rate and branch patent rate. We found an instant maneuver success rate (with successful fenestration in TEVAR) of 98.8 %. There were 696 aortic stent grafts implanted and 726 bridging stents among all the patients. The operation time was 85.8 ± 35.3 min, and the contrast dosedose was 85.2 ± 22.0 ml. Eight bailout stent grafts were implanted into the LSA using the chimney technique (1.2 %), and three cases of fenestration were successfully corrected after misalignment (0.5 %). Large fenestration for the IA, LCCA, and LSA simultaneously was successful in 5 patients (0.8 %). In addition, There were 15 cases (2.3 %) that used SF combined with other techniques (in-situ fenestration, chimney, snorkel, or bypass methods) according to the “HENDO” consensus in China. The peri-operative mortality was 0.5 % (within 30 days of SF-TEVAR procedures). Endoleak was observed in 53 patients (8.1 %) immediately after procedure DSA and in 47 patients (7.1 %) beyond 30 days after the procedure during follow-up. In the 90 months of follow-up data, the overall survival rate was 96.5 %, with a branch artery patent rate of 98.8 %. The well-established SF method that uses radiopaque markers in aortic stent graft to guide physician-modified fenestration in TEVAR is a safe and effective procedure that leads to durable long-term results. Moreover, the survival rate and branch patent rate are both acceptable. This SF-TEVAR is thus a viable alternative method to keep branch arteries patent in cases of aortic arch pathologies.

Topics

Aortic Disease and Treatment Approaches Aortic aneurysm repair treatments Cardiac Valve Diseases and Treatments

Identifiers

DOI: 10.1016/j.asjsur.2025.03.317

Citations and references

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