Short-Term Outcomes of In Situ Fenestration in Total Endovascular Aortic Arch Treatment

Objectives: The aim of this study was to analyze the short-term outcomes of in situ fenestration and discuss its feasibility and safety for the treatment of aortic dissection or aneurysm involving aortic arch. Methods: A retrospective single-center review was conducted on patients who were treated with ISF technique to revascularize supra-arch branches from Jun 2017 to Oct 2019. Computed tomographic angiography was performed to assess the patency of bridging stents, endoleaks and prognosis prior to discharge, after 3 months, 6 months, 12 months and yearly thereafter. Patient demographics, operative details, clinical outcomes, and complications were analyzed and then discussed in this paper. Results: A total of 21 patients were diagnosed with arch pathologies, 5 type A aortic dissections, 12 type B aortic dissections and 4 thoracic aortic aneurysms. There were 19 men and 2 women (mean age 60.7 +/- 15.3). 8 cases were treated with three-fenestration stent grafts, 1 case with two-fenestration stent graft, and 12 cases with single-fenestration stent grafts. Overall technical success rate was 95.2%. Mean operation time was 227.4 +/- 143.8 minutes. Complications were intraoperative hemorrhage ( >1000 ml, 2), stroke (2), hydropericardium (1) and endoleaks (2 type., 1 type.). There was no aorta-related mortality or late endoleaks during the mean follow-up of 25.5 +/- 6.2 months. All the bridging stents remained patent and there was no migration according to follow-up Computed tomographic angiography. Conclusions: With low complication and mortality rate, ISF is an effective and feasible method for the total endovascular aortic arch repair. Long-term follow-up study is needed to evaluate its durability.