BACKGROUND: Thoracic endovascular aortic repair assistive techniques adapt endovascular solutions to aortic arcus and allows sufficient sealing zones while revascularizing the branch vessels. We aimed to assess the safety, feasibility and effectiveness of surgeon modified fenestrated stent graft (SMFSG) technique for zone 2 aortic pathologies in elective and urgent settings at the early and mid-term period with Lifetech Ankura Thoracic (LTA) endograft.
METHODS: During January 2020 and January 2024, 34 patients all having thoracic aortic pathology including Zone 2 and revascularization for left subclavian artery (LSA) with SMFSG were retrospectively evaluated. The primary endpoints at 30 days and during the follow up period were overall mortality, aorta-related mortality (ARM). The secondary end-points were endoleak, patency of LSA and reinterventions in the follow-up period. 10 mm of distance between Left Common Carotid Artery (LCCA) and LSA was the mainstay of our SMFSG technique to ensure graft durability and integrity.
RESULTS: The mean age of the patient cohort was 56.6±11.2 (34-82) years. 30 patients (88.2%) were male. 37 thoracic endografts were used in 34 patients. Mean length of the TEVAR grafts were 17.8±3.1 cm. In our patient population 8 patient had primary BES deployment (23.5%) for LSA. There was no open conversion to surgery, no additional assistive techniques and no need for a bail-out procedure. Mean intensive care unit period was 10.3±4.1 hours (4-24 hours). Mean length of stay was 3.8±1.4 days (3-6 days). The fenestration procedure took a mean period of 11.3±4.2 minutes (8-18 minutes). The fluoroscopy period was 9.1±4.3 minutes (4-22 minutes). LSA patency rate before discharge was 100%. The follow-up period was 32.8±9.4 months (4-29 months). Secondary patency rate for LSA was 96.5% for the follow-up period with one occlusion at the first month control. One patient died at the 28th month due to cardiac causes.
CONCLUSIONS: SMFSG via LTA endograft is a safe, effective and simple technique for zone 2 landing without any additional assistive procedures. It is always available and can be applied to every aortic pathology whether elective or urgent if the anatomy is suitable. Longer follow-up will show the material fatigue or durability of e-PTFE.
