Physician-Modified Thoracic Stent-Grafts for the Treatment of Aortic Arch Lesions

Abstract

Purpose: To evaluate outcomes of physician-modified thoracic stent-grafts for the treatment of aortic arch aneurysms.

Methods: A retrospective dual-center analysis was performed involving 36 patients (mean age 74.7±9 years, range 58-91; 27 men) with an aortic arch lesion who were treated between November 2013 and June 2016 using physician-modified thoracic stent-grafts. Half of the patients had a degenerative aneurysm; the remainder had type B dissection (n=9), traumatic transection (n=3), type Ia endoleak after previous endografting (n=5), or aortoesophageal fistula (n=1). All patients were considered to be at high surgical risk. Patients were treated using an aortic arch stent-graft with a single fenestration (n=24) or a proximal scallop (n=12); zone 0 was involved in 16 patients, zone 1 in 9, and zone 2 in 11. The modified thoracic stent-graft was deployed after supra-aortic branch revascularization in 24 (67%) patients.

Results: Mean time required for stent-graft modifications was 18 minutes (range 14-21). Technical success was obtained in all cases with no type I endoleak. One (3%) patient had a stroke without permanent sequelae. The 30-day mortality was 6%. During a mean follow-up of 11.4±6 months (range 2-36), there were no conversions to open repair. The overall mortality was 14%; aorta-related mortality was 6%.

Conclusion: Our experience suggests that physician-modified thoracic stent-grafts are feasible for aortic arch lesions and provide encouraging results in the short term. Durability concerns will need to be assessed.

Keywords: aneurysm; aortic arch; dissection; endograft; fenestration; physician-modified stent-grafts; scallop; surgeon-modified stent-graft; thoracic endovascular aortic repair.