Outcomes of Surgically Assisted SDRNP for Three-Fenestration Stent Grafts in Treatment of Aortic Arch Pathologies

Summary

The reconstruction of aortic arch vessels is one of the most important and difficult processes in treating aortic arch diseases. This article presents the application of surgically assisted short-distance retrograde needle puncture technique for three-fenestration stent grafts in treating aortic aneurysm, dissection or penetrating ulcers involving aortic arch.

Abstract

Thoracic endovascular aortic repair (TEVAR) has become the preferred method in the treatment of aortic arch diseases by now. Due to the complex anatomical structure and reconstruction techniques, it is difficult to perform total endovascular aortic arch treatment for patients with aortic arch lesions. Our team initiates the reconstruction of aortic arch vessels using the surgically assisted short-distance retrograde needle puncture (SDRNP) technique for three-fenestration stent grafts. This article aims to demonstrate the feasibility and safety of performing the SDRNP technique for three-fenestration stent grafts in treating aortic aneurysm, dissection, or penetrating ulcer involving the aortic arch. A retrospective review was performed on 12 patients with aortic arch diseases, who underwent surgically assisted SDRNP technique for three-fenestration stent grafts to revascularize supra-arch branches. The overall technical success rate was 100.0% (12/12). The average operative time and intraoperative bleeding were 228.5 ± 69.6 min and 74.5 ± 26.9 mL, respectively. Complications consisted of 1 stroke, 1 acute myocardial infarction, and 2 endoleaks (1 type III and 1 type I). The patient with type III endoleaks improved after coil embolization after re-intervention. There were no aorta-related deaths during the average follow-up of 10.3 ± 2.8 months. All of the bridging stents were patent, with no migration. The three-fenestration stent grafts using the surgically assisted SDRNP technique offer a great advance for the treatment of aortic arch diseases, which might be an ideal operation process for aortic arch vessels.

Introduction

Total arch replacement was considered a conventional surgical treatment. Previous studies showed that despite improvements in the surgical techniques, the trauma and risks associated with total arch replacement remained relatively high^1,2. The current strategies of thoracic endovascular repair (TEVAR) with the reconstruction of branch vessels, including TEVAR + DeBranching, TEVAR + Chimney /in situ fenestration technology, and so on, have some limitations, such as the aortic tortuosity and inadequate landing zone^3,4. Due to the complex anatomy....

Protocol

This study retrospectively analyzed the data from 12 patients with aortic arch lesions admitted to our center from March 2021 to March 2024, who were treated with TEVAR combined with the surgically assisted (SDRNP) technique for three-fenestration stent grafts. This study was permitted by the Ethics Committee of the Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (2021-N-17). Informed consent was obtained from all patients for this study.

Patient selection

For this study, the patients included were aged >18 years with aortic arch lesions (Figur....

Results

Between March 2021 and March 2024, 12 patients underwent successful TEVAR combined with the surgically assisted (SDRNP) technique for three-fenestration stent grafts (Table 1). The stents for the fenestration of aortic arch vessels were c-TAG-covered stents. Ankura stent was considered to be implanted according to the distal lesions of the descending aorta. The average age was 62.1 ± 9.5 years and the average follow-up was 10.3 ± 2.8 months.

None were converted to open surgery.......

Discussion

In the TEVAR technique, at least a 15 mm proximal landing zone is needed to treat the aortic arch diseases, because the coverage of supra-arch vessels is necessary to get an adequate seal. TEVAR + DeBranching technique could be applied without concern for the proximal landing zone. Compared with total arch replacement, this approach was less traumatic but still showed a certain incidence of cerebral infarction and mortality¹³. Among the endovascular reconstruction methods of aortic supra-arch vess.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Ankura stent	LifeTech Scientific Corporation, China	XJZDZ3026160
Balloon-expandable covered stent	BARD HEALTHCARE SCIENCE CO., LTD., China	LSM0801038
C-TAG covered stent	Gore Company, USA	TGU373720
High-pressure balloon	Boston Scientific Corporation, USA	H74939171100810
Lunderquist Wire	Cook Medical Trading Co., LTD, USA	TSMG-35-260-LES
Polypropylene suture (5-0)	PROLENE ETHICON, Johnson & Johnson Corporation, USA	EPH8710
Puncture needle	Hakko Co, LTD, Japan	18G*150mm
SPSS software	International Business Machines Corporation, USA	Version 22.0
Supercore wire	Abbott Laboratories, USA	No.100270302
Vascular sheath	Terumo Corporation, Japan	RS*A10K10SQ
Vessel suture instruments	Perclose ProGlide Suture-Mediated Closure System, Abbott Laboratories, USA	No.12673