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Multicenter Study
. 2024 Oct 1;66(4):ezae332.
doi: 10.1093/ejcts/ezae332.

Preliminary experience of the isolate left subclavian artery in-situ fenestration during 'zone 2' thoracic endovascular aortic repair

Gabriele Piffaretti  1 , Andrea Gaggiano  2 , Giovanni Pratesi  3 , Valerio Tolva  4 , Davide Pacini  5 , Raffaele Pulli  6 , Santi Trimarchi  7 , Luca Bertoglio  8 , Domenico Angiletta  9 ; AIDA (Ankura Italian Data Collection) Group
Collaborators, Affiliations
Multicenter Study

Preliminary experience of the isolate left subclavian artery in-situ fenestration during 'zone 2' thoracic endovascular aortic repair

Gabriele Piffaretti et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: To evaluate the results of isolated left subclavian artery in-situ fenestration (ISF) during 'zone 2' thoracic endovascular aortic repair (TEVAR) using a new adjustable needle puncturing device system.

Methods: It is a multicentre, retrospective, physician-initiated cohort study of patients treated from 28 July 2021 to 3 April 2024. Inclusion criteria were isolate left subclavian artery revascularization for elective or urgent/emergent 'zone 2' TEVAR. The primary outcome was technical success and freedom from ISF TEVAR-related reintervention or endoleak.

Results: We treated 50 patients: 28 (56.0%) atherosclerotic thoracic aneurysms, 12 (24.0%) type B aortic dissection and 10 (20.0%) penetrating aortic ulcers. Elective intervention was carried out in 46 (92.0%) cases. ISF was successful in all cases, with a procedural primary technical success in 47 (94.0%) cases. The median time of intervention was 184 min (interquartile range 135-220) with a median fenestration time of 20 min (interquartile range 13-35). Operative mortality did not occur. We observed 1 case of spinal cord ischaemia and 2 cases of bilateral posterior non-disabling stroke. Mortality at 30 days occurred in 1 (2.0%) patient (not aorta-related). The median follow-up was 4 months (interquartile range 1-12.25). Bridging stent graft patency was 100% with no ISF-related endoleak. ISF-related reintervention was never required.

Conclusions: ISF TEVAR using the Ankura™-II device with the self-centring adjustable needle system showed high technical success, promising stability and stable aortic-related outcomes. Owing to these results, it represents a safe and effective alternative for standard 'zone 2' TEVAR.

Keywords: In-situ fenestration; Adjustable needle; Left subclavian artery fenestration; TEVAR; ‘zone 2’.

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Figures

None
Graphical abstract
Figure 1:
Figure 1:
Intraoperative angiographic steps of ISF TEVAR for a descending thoracic post-dissection aneurysm (case #26). EG deployment (A). Needle-driven (white arrow) fenestration through a balloon-stabilized steerable sheath positioned in direct contact with the outer curvature of the EG (B, asterisk). Balloon dilatation of the ISF (C) and (n.2) bridging stent graft connection (C1) with anterograde protrusion to the ascending aorta due to persistent false lumen patency (white arrow) in the LSA. Final completion angiography (D). EG: endograft; ISF: in-situ fenestration; LSA: left subclavian artery; TEVAR: thoracic endovascular aortic repair.
Figure 2:
Figure 2:
Preoperative CT-A (A–C) and 12 months follow-up CT-A (A1, B1, C1) of the descending thoracic post-dissection aneurysm (case #26) showing the complete shrinkage of the sac. Preoperative (D) and 12 months follow-up (D1) volume-rendering 3D CT-A. CT-A: computed tomography-angiography.
Figure 3:
Figure 3:
Consort diagram of all thoracic aortic diseases screened for ISF TEVAR (2021–2024, n = 81). ISF: in-situ fenestration; TEVAR: thoracic endovascular aortic repair.
See this image and copyright information in PMC

References

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