Total aortic arch repair with double-fenestrated physician-modified endografts, at least 3-year follow-up

ABSTRACT

Objective

This study aims to report the efficacy and safety of double-fenestrated physician-modified endovascular grafts (PMEGs) for total aortic arch repair with at least 3 years follow up.

Methods

All consecutive patients with a pathological aortic arch who underwent aortic arch repair combined with homemade double-fenestrated stent-graft from 2017 to 2020 were reviewed.

Results

74 patients were treated for pathological arch conditions with double-fenestrated PMEG. Of these, 81% were male, the mean age was 69.9 years old, and 59% were classified as ASA 3 or 4. 35% were treated for post-dissection aneurysm, 36% for degenerative aneurysm and 14% for acute type B dissection. 15% had supra-aortic trunk dissection. Fenestration on the subclavian artery was performed in 96%; if not, a carotid-subclavian bypass was carried out. Technical success was 100%. The proximal landing zone is consistently in zone 0. Early outcomes revealed a 3% occurrence of type 1 endoleak, which was successfully treated by prompt reintervention. One retrograde dissection occurred, and one patient died from hemorrhage on a iliac conduit. A 5% stroke rate was reported. During long-term follow-up (mean time 40.7 months), one type 1 endoleak appeared and was successfully treated; no type 2 or type 3 endoleak requiring intervention occurred. No stent fractures or migrations were reported. 4% of patients required reintervention but no surgical conversion to open surgical repair was needed on the aortic arch. No patient died from a cause related to the main procedure.

Conclusion

Total aortic arch repair with double-fenestrated PMEGs is associated with acceptable early and midterm major morbidity and mortality. It is suitable for the main aortic pathologies. Moreover, it is easily available for emergency situations.