Laser in situ fenestration with thoracic endovascular aortic repair in treatment of aortic dissection involving arch branches: short-term result and complications

Abstract

Objective To evaluate the surgical effect and complication of laser in situ fenestration with thoracic endovascular aortic repair (TEVAR) in the patients with aortic dissection involving arch branches. Methods From December 2018 to December 2020, 181 patients with aortic dissection involving arch branches admitted to our hospital were analyzed retrospectively among whom 172 patients had laser in situ fenestration with TEVAR. The inclusion criteria were dissection involved aortic arch and the process of TEVAR required reconstruction of the branched vessels in arch. Patients both with aortic dissection lesions less than 15 mm from the coronary ostium and the diameter of ascending aorta more than 45 mm were excluded. Results All cases underwent laser in situ fenestration with TEVAR including 37 cases (21.51%) in acute stage and 135 cases (78.49%) in subacute stage and 165 cases (95.93%) with success of reconstruction of branch vessels. In-hospital death occurred in 6 cases (3.49%), stroke in 2 cases (1.16%), paraplegia in 4 cases (2.33%), proximal stent-graft induced new entry (SINE) in 2 cases (1.16%), and without distal SINE. A total of 168 cases (97.67%) were followed-up. There were 311 branch vessels reconstructed. Follow-up CT angiography was done(10.6±5.4) months which showed that 295 branch vessels were patency with patency rate 94.86%. The partial or complete false lumen thrombosis of thoracic aorta was found in 152 cases (88.37%). Conclusions Laser in situ fenestration with TEVAR was performed with high success rate and low complication rate for the patients with aortic dissection involving arch branches. Long-term follow-up and large sample studies are needed for long-term clinical effects.

Keywords

• |aortic dissection|endovascular repair|reconstruction of branched vessel|laser in situ fenestration|complication