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Midterm results of laser generated in situ fenestration of the left subclavian artery during thoracic endovascular aneurysm repair

Sonesson, Björn LU ; Dias, Nuno LU ; Abdulrasak, Mohammed LU and Resch, Tim LU (2018) In Journal of Vascular Surgery
Abstract

Objective: To analyze the midterm result of in situ fenestration (ISF) of the left subclavian artery (LSA) during thoracic endovascular aneurysm repair (TEVAR). Methods: In this clinical study, between 2014 and 2016, ISF for LSA revascularization was attempted during TEVAR in 10 patients (7 males; median age, 68 years). An excimer laser, placed from the left brachial artery, was used to create a fenestration and all fenestrations were stented with covered stent grafts. Follow-up included computed tomography scans 1 month postoperatively and annually thereafter. Survival was analyzed according to Kaplan-Meier. Results: Nine of the 10 laser-assisted ISF were successful. No 30-day mortality occurred. One patient had a transient ischemic... (More)

Objective: To analyze the midterm result of in situ fenestration (ISF) of the left subclavian artery (LSA) during thoracic endovascular aneurysm repair (TEVAR). Methods: In this clinical study, between 2014 and 2016, ISF for LSA revascularization was attempted during TEVAR in 10 patients (7 males; median age, 68 years). An excimer laser, placed from the left brachial artery, was used to create a fenestration and all fenestrations were stented with covered stent grafts. Follow-up included computed tomography scans 1 month postoperatively and annually thereafter. Survival was analyzed according to Kaplan-Meier. Results: Nine of the 10 laser-assisted ISF were successful. No 30-day mortality occurred. One patient had a transient ischemic attacked in the left carotid territory. After a median follow-up of 27 months, all fenestrations were patent. At 1 month, computed tomography follow-up showed nonspecific endoleaks of unknown origin in five of the nine patients. At 27 months follow-up, only two endoleaks remained. One reintervention was done after 24 months owing to a type Ic endoleak from the LSA. Overall TEVAR success, defined as survival with no aneurysm expansion, was eight of nine. One patient showed aneurysm expansion after 14 months. Two deaths occurred (at 33 and 31 months postoperative), one of unknown reason and one aneurysm related. Conclusions: Laser fenestration might be an option for LSA revascularization during emergent or semiurgent TEVAR and electively in patients with hostile neck anatomy (eg, previous neck radiation, short and adipose necks) that might make a carotid–subclavian bypass difficult. The LSA fenestration has excellent patency and TEVAR success was not affected by nonspecific endoleaks around the LSA.

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author
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
In situ fenestration, Laser, Left subclavian revascularization, TEVAR
in
Journal of Vascular Surgery
publisher
Mosby
external identifiers
  • scopus:85058971586
ISSN
0741-5214
DOI
10.1016/j.jvs.2018.09.052
language
English
LU publication?
no
id
355bd49c-9e2a-4057-83ee-f182a868ad65
date added to LUP
2019-01-08 13:30:32
date last changed
2019-01-09 03:00:03
@article{355bd49c-9e2a-4057-83ee-f182a868ad65,
  abstract     = {<p>Objective: To analyze the midterm result of in situ fenestration (ISF) of the left subclavian artery (LSA) during thoracic endovascular aneurysm repair (TEVAR). Methods: In this clinical study, between 2014 and 2016, ISF for LSA revascularization was attempted during TEVAR in 10 patients (7 males; median age, 68 years). An excimer laser, placed from the left brachial artery, was used to create a fenestration and all fenestrations were stented with covered stent grafts. Follow-up included computed tomography scans 1 month postoperatively and annually thereafter. Survival was analyzed according to Kaplan-Meier. Results: Nine of the 10 laser-assisted ISF were successful. No 30-day mortality occurred. One patient had a transient ischemic attacked in the left carotid territory. After a median follow-up of 27 months, all fenestrations were patent. At 1 month, computed tomography follow-up showed nonspecific endoleaks of unknown origin in five of the nine patients. At 27 months follow-up, only two endoleaks remained. One reintervention was done after 24 months owing to a type Ic endoleak from the LSA. Overall TEVAR success, defined as survival with no aneurysm expansion, was eight of nine. One patient showed aneurysm expansion after 14 months. Two deaths occurred (at 33 and 31 months postoperative), one of unknown reason and one aneurysm related. Conclusions: Laser fenestration might be an option for LSA revascularization during emergent or semiurgent TEVAR and electively in patients with hostile neck anatomy (eg, previous neck radiation, short and adipose necks) that might make a carotid–subclavian bypass difficult. The LSA fenestration has excellent patency and TEVAR success was not affected by nonspecific endoleaks around the LSA.</p>},
  author       = {Sonesson, Björn and Dias, Nuno and Abdulrasak, Mohammed and Resch, Tim},
  issn         = {0741-5214},
  keyword      = {In situ fenestration,Laser,Left subclavian revascularization,TEVAR},
  language     = {eng},
  month        = {12},
  publisher    = {Mosby},
  series       = {Journal of Vascular Surgery},
  title        = {Midterm results of laser generated in situ fenestration of the left subclavian artery during thoracic endovascular aneurysm repair},
  url          = {http://dx.doi.org/10.1016/j.jvs.2018.09.052},
  year         = {2018},
}