Image_3_The Mini-Cross Prefenestration for Endovascular Repair of Aortic Arch Pathologies.JPEG
Objective: To examine the feasibility, integrity, efficacy, and safety of endovascular repair of the aortic arch pathologies with the mini-cross prefenestration (MCPF) on stent grafts.
Methods: First, to prove the feasibility of the MCPF, an in-vitro prefenestration experiment was conducted. Second, to examine the integrity of the MCPF stent grafts, a fatigue test was conducted. Then, the membranes and metal structures of stent grafts were examined by light microscopy and scanning electron microscopy (SEM). Third, a clinical experiment was conducted to investigate the efficacy and safety of this novel technique (ClinicalTrials.gov Identifier: NCT04544579).
Results: All the 12 branch stents were successfully implanted and flared in vitro. After the fatigue test stimulating a 5-year cardiac cycle, no obvious disintegration or fracture was found in light microscopy or SEM. From December 2017 to February 2020, 26 patients with left subclavian arteries and/or left common carotid arteries involved received the novel technique. The endovascular repair with the MCPF was successfully performed on all the 26 (100%) patients. Eighteen (69.2%) patients underwent the reconstruction of the left subclavian artery (LSCA) only. The fenestrations of both the LSCA and left common carotid artery (LCCA) were conducted in 8 (30.8%) patients. Median operative time was 120 [interquartile range (IQR), 95–137.5] min and median revascularization time of the LSCA and LCCA was 30.5 (IQR, 22.8–42.0) s and 20.0 (IQR, 18.0–32.0) s separately. During the median follow-up duration of 38.9 (range, 18.8–44.2) months, one case needed an open surgery because of retrograde type A aortic dissection 3 months after implantation and no other complications or mortality occurred. The maximum aortic diameters were significantly decreased in patients with thoracic aortic dissection and thoracic aortic aneurysm (p < 0.05).
Conclusion: The existing evidence demonstrated the safety, rapid branch artery revascularization, and positive aortic remodeling of the novel technique. Long-term observation is warranted to prove the durability.
History
References
- https://doi.org//10.1016/j.jacc.2016.07.772
- https://doi.org//10.1016/j.ejvs.2016.03.025
- https://doi.org//10.1016/j.ejvs.2021.05.012
- https://doi.org//10.1016/j.avsg.2019.02.002
- https://doi.org//10.1016/j.jvs.2010.11.120
- https://doi.org//10.1583/07-2111.1
- https://doi.org//10.1016/j.jtcvs.2019.10.184
- https://doi.org//10.1002/jbm.b.33393
- https://doi.org//10.1093/ejcts/ezt241
- https://doi.org//10.1016/j.ejvs.2018.09.016
- https://doi.org//10.1016/j.jvs.2020.07.087
- https://doi.org//10.1016/j.jvs.2007.08.020
- https://doi.org//10.1016/j.jvs.2014.08.114
- https://doi.org//10.1053/j.semvascsurg.2009.07.007
- https://doi.org//10.1016/j.jvs.2016.10.111
- https://doi.org//10.1016/j.jacc.2009.11.047
- https://doi.org//10.1016/j.jvir.2015.07.022
- https://doi.org//10.1177/1526602818772311
- https://doi.org//10.1016/j.ejvs.2020.08.022
- https://doi.org//10.1016/j.jtcvs.2019.07.096
- https://doi.org//10.1093/ejcts/ezz049
- https://doi.org//10.1016/j.avsg.2020.05.062
- https://doi.org//10.1016/j.ejvs.2021.09.028
- https://doi.org//10.1016/j.jtcvs.2016.06.027
- https://doi.org//10.1016/j.cjca.2021.04.024
- https://doi.org//10.1016/j.ejvs.2018.03.016
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