Skip to main content
SpringerLink
Log in

Early Experience and Lessons Learnt with Customized Fenestrated Thoracic Endovascular Aortic Reconstruction for Aortic Arch Pathology in an Asian Population

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

Thoracic endovascular aortic repair (TEVAR) is the preferred treatment of descending thoracic aorta pathology. However, TEVAR in the aortic arch remains challenging. Customized fenestrated TEVAR (fTEVAR) allows extension of the proximal seal zone, while preserving the involved supra-aortic vessels. There is a paucity of information on fTEVAR; hence, we aim to evaluate our early experience and lessons learnt with fTEVAR in the aortic arch.

Methods

This is a retrospective single-centre review of fTEVAR endografts for aortic arch pathology over 24 months. Seven patients with mean age of 72.8 years (range 63–84 years) were included. A total of 15 supra-aortic branches were treated [left subclavian artery (n = 7), left carotid artery (n = 5), innominate artery (n = 1), bovine origins (n = 2)], involving a total of nine fenestrations and six scallops. No supra-aortic debranching was required.

Results

Median follow-up was 15 months. Technical success was 86%, and one patient had malalignment of the fTEVAR endograft requiring salvage with double chimney technique. There were no early endoleaks with one type 2 endoleak detected in the follow-up period. Two access site pseudoaneurysms required intervention. There was a learning curve involved reflected by higher than average mean operative time of 224 min with average radiation dose of 3029.86 mGy and mean contrast volume of 283 mls.

Conclusion

fTEVAR in the aortic arch is feasible in Asian patients, although there was a learning curve involved, and careful patient selection is advised. Longer term data in a larger population are required to assess its durability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med. 1994;331:1729–34.

    Article  CAS  PubMed  Google Scholar 

  2. Moon MC, Morales JP, Greenberg RK. The aortic arch and ascending aorta: are they within the endovascular realm. Semin Vasc Surg. 2007;20:97–107.

    Article  CAS  PubMed  Google Scholar 

  3. Iba Y, Minatoya K, Matsuda H, Sasaki H, Tanaka H, Kobayashi J, et al. Contemporary open aortic arch repair with selective cerebral perfusion in the era of endovascular aortic repair. J Thorac Cardiovasc Surg. 2013;145(Suppl):S72–7.

    Article  PubMed  Google Scholar 

  4. Mangialardi N, Serrao E, Kasemi H, Alberti V, Fazzini S, Ronchey S. Chimney technique for aortic arch pathologies: an 11 year single-center experience. J Endovasc Ther. 2014;21:312–23.

    Article  PubMed  Google Scholar 

  5. Kolvenbach RR, Rabin A, Karmeli R, Alpaslan A, Schwierz E. Developments in parallel grafts for aortic arch lesions. J Cardiovasc Surg. 2016;57:448–56.

    Google Scholar 

  6. Longo GM, Pipinos II. Endovascular techniques for arch vessel reconstruction. J Vasc Surg. 2010;52:71S–81S.

    Article  Google Scholar 

  7. Tse LW, Lindsay TF, Roche-Nagle G, Oreopoulos GD, Ouzounian M, Tan KT. Radiofrequency in situ fenestration for aortic arch vessels during thoracic endovascular repair. J Endovasc Ther. 2015;22(1):116–21.

    Article  PubMed  Google Scholar 

  8. Antoniou GA, El Sakka K, Hamady M, Wolfe JHN. Hybrid treatment of complex aortic arch disease with supra-aortic debranching and endovascular stent graft repair. Eur J Vasc Endovasc Surg. 2010;39:683–90.

    Article  CAS  PubMed  Google Scholar 

  9. Geisbusch P, Kotelis D, Muller-Eschner M, Hyhlik-Durr A, Bockler D. Complications after aortic arch hybrid repair. J Vasc Surg. 2011;53:935–41.

    Article  PubMed  Google Scholar 

  10. Haulon S, Grennberg RK, Spear R, Eagleton M, Abraham C, Lioupis C, Verhoeven E, Ivancev K, Kolbel T, Stanley B, Resch T, Desgranges P, Maurel B, Roeder B, Chuter T, Mastracci T. Global experience with an inner branched arch endograft. J Thorac Cardiovasc Surg. 2014;148:1709–16.

    Article  PubMed  Google Scholar 

  11. Tsilimparis N, Debus ES, von Kodolitsch Y, Wipper S, Rohlffs F, Detter C, Roeder B, Kolbel T. Branched versus fenestrated endografts for endovascular repair of aortic arch lesions. J Vasc Surg. 2016;64:592–9.

    Article  PubMed  Google Scholar 

  12. O’Callaghan A, Mastracci TM, Greenberg RK, Eagleton MJ, Bena J, Kuramochi Y. Outcomes for supra-aortic branch vessel stenting in the treatment of thoracic aortic disease. J Vasc Surg. 2014;60:914–20.

    Article  PubMed  Google Scholar 

  13. Lee WA, Brown MP, Nelson PR, Huber TS. Total percutaneous access for endovascular aortic aneurysm repair (“preclose technique”). J Vasc Surg. 2007;45:1095–101.

    Article  PubMed  Google Scholar 

  14. Cheng SW, Ting AC, Ho P, Poon JT. Aortic aneurysm morphology in Asians: features affecting stent graft application and design. J Endovasc Ther. 2004;11(6):605–12.

    Article  PubMed  Google Scholar 

  15. Rizvi AZ, Murad MH, Fairman RM, Erwin PJ, Montori VM. The effect of left sub-clavian artery coverage on morbidity and mortality in patients undergoing endo-vascular thoracic aortic interventions: a systematic review and meta-analysis. J Vasc Surg. 2009;50:1159–69.

    Article  PubMed  Google Scholar 

  16. Si Y, Fu W, Liu Z, Zuo C, Shi X, Wang Y, Guo D, Xu Q, Chen B. Coverage of the left subclavian artery without revascularization during thoracic endovascular repair is feasible: a prospective study. Ann Vasc Surg. 2014;28(4):850–9.

    Article  PubMed  Google Scholar 

  17. Dexter D, Maldonado TS. Left subclavian artery coverage during TEVAR: is revascularization necessary? J Cardiovasc Surg (Torino). 2012;53:135–41.

    CAS  Google Scholar 

  18. Feezor RJ, Martin TD, Hess PJ, Klodell CT, Beaver TM, Huber TS, et al. Risk factors for perioperative stroke during thoracic endovascular aortic repairs (TEVAR). J Endovasc Ther. 2007;14:568–73.

    Article  PubMed  Google Scholar 

  19. Matsumura JS, Lee WA, Mitchell RS, Farber MA, Murad MH, Lumsden AB, Greenberg RK, Safi HJ, Fairman RM. Society for vascular surgery. The society for vascular surgery practice guidelines: management of the left subclavian artery with thoracic endovascular aortic repair. J Vasc Surg. 2009;50(5):1155–8.

    Article  PubMed  Google Scholar 

  20. Iwakoshi S, Ichihashi S, Itoh H, Tabayashi N, Sakaguchi S, Yoshida T, Nakao Y, Kichikawa K. Clinical outcomes of thoracic endovascular aneurysm repair using commercially available fenestrated stent graft (Najuta endograft). J Vasc Surg. 2015;62:1473–8.

    Article  PubMed  Google Scholar 

  21. Lemke AJ, Benndorf G, Liebig T, Felix R. Anomalous origin of the right vertebral artery: review of the literature and case report of right vertebral artery origin distal to left subclavian artery. AJNR Am J Neuroradiol. 1999;20:1318–20.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore

    Glenn Wei Leong Tan

  2. Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore

    Lawrence Quek, Bien Peng Tan & Uei Pua

Authors
  1. Glenn Wei Leong Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lawrence Quek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bien Peng Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Uei Pua
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Glenn Wei Leong Tan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Movie 1

Fluoroscopic video of Patient 1 demonstrating a wire-wrap situation. Reference to Fig. 3A is suggested. Note the wrapping of the body-floss wire over the proximal stent, constraining it from full deployment. Note how the proximal stent expands and constricts with tension of the body-floss wire (WMV 10593 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tan, G.W.L., Quek, L., Tan, B.P. et al. Early Experience and Lessons Learnt with Customized Fenestrated Thoracic Endovascular Aortic Reconstruction for Aortic Arch Pathology in an Asian Population. Cardiovasc Intervent Radiol 41, 544–553 (2018). https://doi.org/10.1007/s00270-017-1858-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-017-1858-z

Keywords

Search

Navigation