Outcomes of fenestrated endovascular abdominal aortic repair in distal entry tears of chronic debakey IIIb aortic dissection

Abstract

Currently, there have been very few reports within the literature which specifically address using fenestrated and branched stent grafts to completely isolate and repair distal entry tears of chronic DeBakey IIIb aortic dissection. This study aimed to evaluate the clinical outcomes of a 3-dimensional (3D) printed aortic model-guided fenestrated stent in the treatment of distal tears of chronic DeBakey IIIb aortic dissection after thoracic endovascular aortic repair (TEVAR). The study was a one-center retrospective study comprising 36 patients who underwent TEVAR and fenestrated endovascular abdominal aortic repair (F-EVAR) between April 2014 and December 2022. Patient data was compiled and analysed for preoperative, intraoperative, and perioperative characteristics. In total, 36 patients (12 females and 24 males) were incorporated into this study. All of the patients included in this study had hypertension, and among them, the leading cause for undergoing II-stage F-EVAR was the progression of a false lumen, accounting for 24 cases (66.7% of the total). The technical success rate was 97.2% and there were no cases of 30-day mortality, myocardial infarction, permanent paraparesis, or organ failure. One year post-F-EVAR treatment, surviving patients showed significant false and true lumen remodelling with 100% complete false-lumen thrombosis. A total of five patients died during the follow-up, two patients died related to aorta complications and three patients died of heart failure, multiple organ failure, or septic shock. II-stage F-EVAR was safe and feasible operation to repair all distal tears of chronic DeBakey IIIb aortic dissection.

Fig 1. Preparation of a four-vessel fenestrated endograft using a 3-dimensional (3D) printed model.

(A) The main aortic stent-graft was completely released in the 3D model, and the position of each fenestration was marked and a wire was sutured around its edge. (B) Super-selected celiac trunk. (C), Super-selective superior mesenteric artery. (D) Super-selective renal artery.

Fig 2. Kaplan-Meier curves (Time units) showing overall survival (A) and aorta-specific survival (B).

Fig 3

Computed tomography angiogram (CTA) of a patient before (A-D) and after (E-H) fenestrated endovascular abdominal aortic repair (F-EVAR) (arrow, false lumen (FL)). (A) Distal residual dissection after thoracic endovascular aortic repair (TEVAR). (B-D) Preoperative CTA showing the true lumen (TL) and FL at the level of the celiac trunk, superior mesenteric artery and renal artery. (E-G) Postoperative CTA showing the TL and FL at the level of the celiac trunk, superior mesenteric artery and renal artery. (H) Three-dimensional reconstruction of the CTA revealing good aortic remodeling with FL shrinkage and TL expansion.