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

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1031068

DOI=10.3389/fcvm.2022.1031068

ISSN=2297-055X

ABSTRACT=Objectives: This study evaluated the feasibility and safety 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: Between March 2016 and April 2021, 47 consecutive patients underwent TEVAR with f-SMSG for TBAD involving the aortic arch. Outcomes included technical success, perioperative and follow-up morbidity and mortality.
Results: During the study period, 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 cases (97.88%). The 30-day estimated survival (±SE) was 93.6% ± 1.0% (95% Confidence Interval [CI], 92.6% to 94.6%). The 30-day estimated freedom from reintervention (±SE) was 91.5% ± 1.2% (95% CI, 90.3% to 92.7%). At a median follow-up of 51 months (range, 16-71 months), 4 patients died, including 1 aortic-related deaths and 3 non-aortic-related death. Four patients had reintervention, including two cases of type IA entry flow and two cases of type IB entry flow. All supra-aortic trunks were patent. The estimated survival (±SE) at 4-year was 88.7% ± 1.4% (95%CI, 87.3% to 90.1%). The estimated freedom from reintervention (±SE) at 4-year was 84.8% ± 1.5% (95%CI, 83.3% to 86.3%).
Conclusions: TEVAR with f-SMSG is an optimal alternate option for treatment of TBAD involving the aortic arch in experienced centers.