Clinical application of the subclavian artery fenestration technique in endovascular repair of thoracic aortic lesions with insufficient proximal landing area
10.3760/cma.j.cn112434-20250302-00064
- VernacularTitle:锁骨下动脉开窗技术在近端锚定区不足胸主动脉病变腔内修复术中的临床应用
- Author:
Xiaofeng HAN
1
;
Xi GUO
;
Guangrui LIU
;
Tiezheng LI
;
Xiaohai MA
;
Zhijiang WANG
Author Information
1. 首都医科大学附属北京安贞医院介入诊疗科，北京 100029
- Publication Type:Journal Article
- Keywords:
Endovascular aortic repair;
Physician modified stent grafts;
In situ fenestration;
bridging stent
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2025;41(8):467-474
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the safety and effectiveness of physician modified stent grafts technique and in situ fenestration technique for reconstructing the left subclavian artery in endovascular repair of thoracic aortic lesions with insufficient proximal landing area.Methods:A retrospective analysis was conducted on the clinical data of 75 patients with aortic arch lesions treated with physician modified stent grafts and in situ fenestration techniques at the Interventional Diagnosis and Treatment Department of Beijing Anzhen Hospital affiliated with Capital Medical University from November 2021 to March 2024. Among them, 52 patients received within physician modified stent grafts (PMSGs group) and 23 patients received in situ fenestration (ISF group). Based on two fenestration techniques, to analyze the technical success rate of endovascular repair in reconstructing the left subclavian artery in the perioperative and early following up adverse events both groups.Results:The success rate of PMSGs group technique was 92.31% (48/52), while the success rate of ISF technique was 91.30%(21/23). In the PMSGs group, there was 1 case of TypeⅠa endoleak and 3 cases of TypeⅠc endoleak immediately during endovascular repair; There was 1 case of TypeⅠa endoleak and 1 case of vascular injury in the ISF group immediately during endovascular repair. One case of perioperative cerebral infarction and one case of transient blindness occurred in the PMSGs group; One case of transient blindness and 1 case of brachial artery thrombosis occurred in the perioperative period in the ISF group. During the follow-up period, there was 1 case of distal dissection aneurysm formation in the PMSGs group, and 3 cases of minor typeⅠc endoleak were found after 3 months; One case of subclavian artery stent occlusion and 2 cases of minor typeⅠc endoleak occurred in the ISF group 6 months later. There were no cases of aortic-related deaths during the follow-up period in both groups. There was no statistically significant difference in the technical success rate, incidence of adverse events during the perioperative period and follow-up period, and re-intervention rate between the two groups. The average fluoroscopy time consumed in the ISF group was significantly higher than that in the PMSGs group (34.57 min vs. 21.42 min, P<0.001), but the average hospitalization time in the PMSGs group was significantly higher than that in the ISF group (9.33 days vs. 4.71 days, P<0.001). Conclusion:PMSGs and ISF techniques for reconstructing the left subclavian artery in the treatment of thoracic aortic arch lesions showed good safety and effectiveness. The appropriate fenestration technique selected based on aorta arch anatomical and lesion conditions could achieve satisfactory efficacy in short-term, but long-term effects need to be further observed.
