Combined physician-modified fenestration and inner branch techniques for aortic pathology with aberrant subclavian artery
10.3760/cma.j.cn112139-20250526-00274
- VernacularTitle:体外预开窗联合内分支技术治疗合并迷走锁骨下动脉的主动脉疾病效果分析
- Author:
Zhaohui HUA
1
;
Hao ZHAO
;
Yongqiang YUE
;
Dongyan SHEN
;
Qingquan LIU
;
Hongtao WANG
;
Qingsheng LIN
;
Kunli CAO
;
Wei LIU
;
Zhen LI
Author Information
1. 郑州大学第一附属医院腔内血管外科，郑州450052
- Publication Type:Journal Article
- Keywords:
Aortic disease;
Aortic aneurysm;
Stanford type B aortic dissection;
Penetrating aortic ulcer;
Aberrant subclavian artery;
Pre-fenestration;
Thoracic endovas
- From:
Chinese Journal of Surgery
2025;63(12):1156-1162
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the early and mid-term efficacy of physician-modified fenestrated endovascular repair combined with inner branch techniques for aortic pathologies complicated by aberrant subclavian artery (ASA).Methods:A retrospective case series was conducted, including 24 patients with ASA-associated aortic pathologies who underwent thoracic endovascular aortic repair (TEVAR) with physician-modified fenestration and inner branch reconstruction at 7 centers in China from February 2021 to March 2025. The cohort comprised 18 males and 6 females, with an age of (54.4±11.7) years (range:37 to 80 years). Pathological diagnoses included aortic aneurysm in 7 patients (29.2%), aortic dissection in 11 (45.8%; 6 chronic, 4 subacute, 1 acute), and penetrating aortic ulcer in 6 (25.0%; 3 with concomitant intramural hematoma). Preoperative planning was performed using three-dimensional CT angiographic reconstruction, incorporating both the greater-curvature hemodynamic length and the centerline wall-adherent length. Fenestration sites were verified on three-dimensional printed models, and precise fenestrations were created at the covered stent-graft locations corresponding to the subclavian artery and ASA anatomy. Patients subsequently underwent TEVAR combined with supra-aortic revascularization as indicated, followed by completion ascending aortography to evaluate the sealing of the main stent-graft and the patency of fenestrated or branched stents. Perioperative outcomes, complications, and early-to mid-term clinical efficacy were analyzed.Results:All procedures were technically successful. Immediate angiography identified one case of minor type Ⅳ endoleak that resolved spontaneously on 3-month follow-up CT angiography, and one case of mild type Ⅱ endoleak that was left untreated with a stable false lumen during follow-up. One patient died on postoperative day 7 of an undetermined cause. The mean follow-up period was (23.1±11.3)months (range:3 to 37 months). During follow-up, one patient developed mild bilateral lower-limb weakness 1 month after surgery. Vascular occlusion and spinal cord infarction were excluded, and the symptoms were considered related to postoperative spinal hemodynamic changes; the weakness resolved after blood pressure adjustment without recurrence. No other complications, including upper limb ischemia, spinal cord ischemia, or posterior circulation ischemia, were observed. Throughout follow-up, all branch and main stents remained patent with good structural integrity, without migration or device-related complications.Conclusions:Physician-modified fenestration combined with inner branch techniques for ASA-associated aortic pathologies is technically feasible and yields satisfactory early and mid-term results. Long-term outcomes require further follow-up.
