Long-Term Patency of In Situ Fenestration for Aortic Arch Vessels in Thoracic Endovascular Repair

Retrospective review was carried out from March 2011 and December 2018. During this period, 11 successful ISF were performed in our facility.  Patient demographics, aneurysm characteristics, and intraoperative and postoperative data were gathered retrospectively.  Specific outcome data related to the ISF were collected including: cerebrovascular events at primary procedure and at follow-up, endoleaks and reintervention rate of insitu fenestration, stentgraft patency and target vessel patency. CT images were reviewed to the last follow-up CT.

Results: Demographic and pre operative data in Table 1. Mean follow-up time was 69 months (range, 14 to 131 months). Two of the patient’s recovery were complicated by intraoperative stroke; one in their left middle cerebral artery following the in-situ fenestration for a branch for their left subclavian artery, and the other suffered from a left middle cerebral and posterior cerebral artery stroke resulting in aphasias and right sided weakness.3 patients died from malignancy, one from myocardial infarction, one from cerebrovascular event on contralateral side of stent, and one from complication of ascending aorta replacement. 

Endoleaks were observed in only 1 patient –type IA and III endoleak. The type 1A endoleak treated by TEVAR cuff extension. Type III endoleak was due to inadequate bridging stent length inside the TEVAR and treated by bridging stent extension. All fenestrated stents and target vessels were patent by postoperative imaging during follow-up. One patent required uneventful re-angioplasty of the common carotid stent which was inadvertently crushed during cardiac surgery.

Conclusion: ISF has high long-term patency rate and low long-term endoleak complications. Cerebrovascular events are still a concern in aortic arch interventions.