Homemade fenestrated stent-graft for thoracic endovascular aortic repair of zone 2 aortic lesions

The Journal of Thoracic and Cardiovascular Surgery

Kiyofumi Morishita¹  Ludovic Canaud²  Thomas Gandet³ 

[1] Department of Cardiovascular Surgery, Hakodate Municipal Hospital, Hakodate, Japan;Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France;Department of Vascular Surgery, Santa Helena Hospital, Florianópolis, Brazil

关键词: physician-modified thoracic stent-grafts;    thoracic endovascular aortic repair;   

DOI  :  10.1016/j.jtcvs.2017.07.045

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveThe 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.MethodsFrom 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.ResultsMedian 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.ConclusionsThe 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.

【 授权许可】

Unknown