Purpose: To assess the early and midterm outcomes of endovascular total aortic arch repair (ETAAR) via in situ micro-needle based fenestration(ISMF) with hardness-enhanced sheath gutter technique for aortic arch pathologies.
Materials and Methods: Between August 2022 to April 2025, a retrospective study was conducted in consecutive patients who underwent ETAAR via ISMF with hardness-enhanced sheath gutter technique for aortic arch pathologies. Operative details, technical success, clinical outcomes and complications were recorded. Continuous data of bilateral RCOS and MAP of bilateral CCA were recorded during procedure. All patients were followed up with computed tomography angiography at 3, 12 months and yearly thereafter.
Results: A total of 36 patients with aortic arch pathology were included, comprising aortic arch aneurysms (n= 27; 75%) and non-A non-B aortic dissections (n=9; 25%). The technical success rate was 94.4%(34/36). Cervical branches reconstruction were successfully performed in all cases. Immediate type Ia endoleakages were found on final angiogram in 2 (5.6%) patients. The mean clinical follow-up was 18.2 ± 8.7 months (range, 1–32 months). The all cause death rate was 11.1% (4/36). One patient with aortic arch aneurysm died of severe pneumonia despite successful endovascular exclusion, leading to a 30-day mortality of 2.8%. Three additional deaths occurred during followup. one died of cerebral hemorrhage at 18 months, one died of liver carcinoma at 24 months, and one died of congestive heart failure at 32 months. The overall stroke rate was 8.3% (3/36). The survival rate at 1 and 3 years was 97.3% ± 2.7% and 85.8% ± 8.1%. The cumulative rate of freedom from reintervention at 1 and 3 years was 87.5% ± 5.9% and 83.2% ± 7.0%.
Conclusion: This study demonstrated the ETAAR via ISMF with hardness-enhanced sheath gutter technique can be performed successfully in aortic arch pathologies with a favourable early and mid term outcome.
