Outcomes of thoracic endovascular aortic repair with fenestrated surgeon-modified stent-graft for type B aortic dissections involving the aortic arch

Xiaoye Li; Lei Zhang; Chao Song; Hao Zhang; Shibo Xia; Yang Yang; Longtu Zhu; Wenying Guo; Qingsheng Lu

doi:10.3389/fcvm.2022.1031068

Outcomes of thoracic endovascular aortic repair with fenestrated surgeon-modified stent-graft for type B aortic dissections involving the aortic arch

Front Cardiovasc Med. 2023 Jan 16:9:1031068. doi: 10.3389/fcvm.2022.1031068. eCollection 2022.

Authors

Xiaoye Li¹, Lei Zhang¹, Chao Song¹, Hao Zhang¹, Shibo Xia¹, Yang Yang², Longtu Zhu¹, Wenying Guo¹, Qingsheng Lu¹

Affiliations

¹ Division of Vascular Surgery, Department of General Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.
² Changhai Hospital, Naval Medical University, Shanghai, China.

Abstract

Objectives: This retrospective analysis aimed to evaluate the early and midterm outcomes of thoracic endovascular aortic repair (TEVAR) with fenestrated surgeon-modified stent-graft (f-SMSG) for type B aortic dissections (TBAD) involving the aortic arch.

Methods: From March 2016 to April 2021, 47 consecutive patients were treated using TEVAR with f-SMSG. All patients were diagnosed with TBAD involving the aortic arch.

Results: In total, 47 patients with TBAD involving the aortic arch were treated with f-SMSGs. There were 21 zone 1 and 26 zone 2 TEVAR, and 65 arteries were revascularized successfully with fenestrations. Technical success was achieved in 46 patients (97.88%). The 30-day estimated survival (± SE) and reintervention was 93.6 ± 1.0% (95% Confidence Interval [CI], 92.6-94.6%) and 91.5 ± 1.2% (95% CI, 90.3-92.7%), respectively. During a median follow-up of 51 months (range, 16-71 months), 1 patient died of rupture of aortic dissection (AD) and 3 patients died of non-aortic-related reasons. Reintervention was performed for four patients, including two patients of type IA entry flow and two patients of type IB entry flow. No occlusion of the supra-aortic trunk was observed. The estimated survival and reintervention (± SE) at 4 years was 88.7 ± 1.4% (95% CI, 87.3-90.1%) and 84.8 ± 1.5% (95% CI, 83.3-86.3%), respectively.

Conclusion: Thoracic endovascular aortic repair with f-SMSG is an alternative treatment option for TBAD involving the aortic arch in high-volume centers.

Keywords: aortic arch; fenestrated surgeon-modified stent-graft; supra-aortic trunks; thoracic endovascular aortic repair; type B aortic dissection.