Technical details of thoracic endovascular aortic repair with fenestrations for thoracic aortic pathologies involving the aortic arch: A Chinese expert consensus

Chenyang Qiu; Zhenjiang Li; Xiangchen Dai; Xinwu Lu; Qingsheng Lu; Xiaoqiang Li; Weimin Zhou; Pingfan Guo; Jun Pan; Donglin Li; Ziheng Wu; Hongkun Zhang

doi:10.3389/fcvm.2022.1056229

Technical details of thoracic endovascular aortic repair with fenestrations for thoracic aortic pathologies involving the aortic arch: A Chinese expert consensus

Front Cardiovasc Med. 2022 Dec 20:9:1056229. doi: 10.3389/fcvm.2022.1056229. eCollection 2022.

Authors

Chenyang Qiu¹, Zhenjiang Li¹, Xiangchen Dai², Xinwu Lu³, Qingsheng Lu⁴, Xiaoqiang Li⁵, Weimin Zhou⁶, Pingfan Guo⁷, Jun Pan¹, Donglin Li¹, Ziheng Wu¹, Hongkun Zhang¹

Affiliations

¹ Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
² Department of Vascular Surgery, General Hospital, Tianjin Medical University, Tianjin, China.
³ Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ Department of Vascular Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China.
⁵ Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, Jiangsu, China.
⁶ Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
⁷ Department of Vascular Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.

Abstract

Thoracic aortic pathologies involving the aortic arch are a great challenge for vascular surgeons. Maintaining the patency of supra-aortic branches while excluding the aortic lesion remains difficult. Thoracic EndoVascular Aortic Repair (TEVAR) with fenestrations provides a feasible and effective approach for this type of disease. The devices needed in the procedure are off-the-shelf, with promising results reported in many medical centers. Up until now, there have been no guidelines focusing exclusively on the details of the TEVAR technique with fenestrations. Experts from China have discussed the technical parts of both in situ fenestrations (needle and laser) and fenestrations in vitro (direction inversion strategy and guidewire-assisted strategy), providing a technical reference to standardize the procedure and improve its results.

Keywords: device; fenestrations; standard procedure protocol; technical details; thoracic endovascular aortic repair.

Publication types

Review