Challenge To The Aortic Arch Treatment With Fenestrated Stent Graft
Hiroyuki Otsuka1, Seiji Onitsuka1, Atsuhisa Tanaka2, Shinichi Nata1, Mau Amako1, Tohru Takaseya1, Satoru Tobinnaga1, Shinichi Hiromatsu1, Hidetoshi Akashi1, Hiroyuki Tanaka1.
1Kurume University School of Medicine, Kurume, Japan, 2Saga University School of Medicine, Saga, Japan.
OBJECTIVE: Thoracic endovascular aortic repair (TEVAR) has widely spread to treatment of thoracic aortic diseases. However, it remains difficult to further expand an indication of simple TEVAR for aortic arch lesions, because additional management of the brachiocephalic and the left common carotid artery is necessary to secure sufficient length of a proximal neck. The Najuta fenestrated stent-graft (Kawasumi, Inc, Tokyo, Japan) has been commercially available for distal aortic arch aneurysms since June 2013 in Japan. We evaluated early and mid-term results of TEVAR using the fenestrated stent-graft (Najuta SG) as a semi-order devise for aortic arch treatment, and describe its clinical usefulness and limitations.
METHODS: Between January 2007 and May 2016, 29 patients were treated with the Najuta SG at our hospital. Early and midterm results were investigated retrospectively. The mean age of the patients was 73.9 years (27 patients were men). Indication was degenerative aortic aneurysms 22 (76%), chronic aortic dissections 6 (21%), pseudoaneurysm 1 (3%). Najuta SGs were placed in zone2 (n=10), zone3 (n=19) and these fenestrations preserved antegrade blood flow into brachiocephalic and the left common carotid artery. The LSA was simply covered by the SG without any reconstruction in the remaining 23 cases (79.5%). 15 cases (52%) were out of adaptation with treatment of using other commercially available tube type SG due to short proximal landing zone.
RESULTS: Technical success rate was 100%. Overall 30-day mortality rate was 0%. Temporary paraplegia was 3.4%. There were no stroke and retrograde aortic dissection. Mean follow-up period was 53.9 months. There was no aneurysm-related death. Type Ia endoleak was detected in 1 aneurysm. The rate of freedom from secondary intervention was 93%, respectively. Device migration was not observed. There was 1 branch (left subclavian artery) occlusion. No other branch occlusion was seen in this follow-up period.
CONCLUSIONS: TEVAR using the Najuta SG were feasible, demonstrating high rate of freedom from aneurysm enlargement and high patency rate of the supra-aortic branches in the treatment of aortic arch pathologies.
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