Fenestrated Physician Modified Endografts for Endovascular Aortic Arch Repair in Zone 0

Qinshu Wen; Yepeng Zhang; Jun Wei; Mingyang Shen; Guangyan Wu; Xiaolong Du; Xiaoqiang Li; Min Zhou

doi:10.1016/j.ejvs.2024.04.008

Fenestrated Physician Modified Endografts for Endovascular Aortic Arch Repair in Zone 0

Eur J Vasc Endovasc Surg. 2024 Apr 17:S1078-5884(24)00344-7. doi: 10.1016/j.ejvs.2024.04.008. Online ahead of print.

Authors

Qinshu Wen¹, Yepeng Zhang¹, Jun Wei², Mingyang Shen³, Guangyan Wu⁴, Xiaolong Du¹, Xiaoqiang Li⁵, Min Zhou⁶

Affiliations

¹ Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
² Department of Cardiac Surgery, the First Affiliated Hospital of Wannan Medical College, Wuhu, China.
³ Department of Vascular Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China; Department of Vascular Surgery, the Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Nanjing, China.
⁴ Department of Vascular Surgery, Medical School of Southeast University, Nanjing Drum Tower Hospital, Nanjing, China.
⁵ Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; Department of Vascular Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.
⁶ Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; Department of Vascular Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China; Department of Vascular Surgery, Medical School of Southeast University, Nanjing Drum Tower Hospital, Nanjing, China. Electronic address: zhouminnju@nju.edu.cn.

PMID: 38641315
DOI: 10.1016/j.ejvs.2024.04.008

Abstract

Objective: This multicentre study aimed to assess the early and midterm outcomes of fenestrated physician modified endografts (PMEGs) for endovascular aortic arch repair in zone 0.

Methods: Between 2018 and 2022, a retrospective study was conducted in three centres of consecutive patients undergoing endovascular aortic arch repair in zone 0 with PMEGs. Endpoints included technical success, 30 day mortality, major adverse events, secondary interventions, stent stability, target vessel patency, and overall survival.

Results: A total of 54 patients (mean age 63 years; 45 males) with aortic arch pathology were included, comprising aortic dissections (n = 32; 59%) and aortic arch aneurysms (n = 22; 41%). Technical success was 98%, and one patient died from stroke within 30 days. Major adverse events included stroke (n = 4; 7%), retrograde type A dissection (RTAD) (n = 3; 6%), and acute kidney injury (n = 2; 4%). During a median follow up of 12 months, there were two deaths (4%) of unknown cause at 1 month and 1.5 months, and no aortic related death. Type Ia, type Ic, and type IIIc endoleaks were observed in 2 (4%), 3 (6%), and 2 (4%) patients, respectively. No vessel stenosis was observed. Re-intervention was required in 10 patients (19%). Estimates of overall survival, freedom from secondary intervention, and freedom from target vessel instability at 1 year were 94.2% (standard error [SE] 3.3%), 81.8% (SE 6.0%), and 92.0% (SE 4.5%), respectively.

Conclusion: This study demonstrated the efficacy of PMEGs for zone 0 endovascular aortic arch repair, with acceptable technical success and mortality rate. Stroke, RTAD, and re-intervention rates remain a concern for endovascular therapy. A larger population and long term outcomes are required to assess the safety and durability of this technique as a beneficial choice for endovascular aortic arch repair in specialised centres.

Keywords: Aortic arch; Aortic arch pathology; Endovascular aortic arch repair; Physician modified endograft; Zone 0.