Application value of diode laser in situ fenestration in the thoracic endovascular aortic repair for the treatment of aortic arch disease

Abstract

Objective To evaluate the application value of diode laser in situ fenestration in the thoracic endovascular aortic repair (TEVAR) for the treatment of aortic arch disease. Methods The retrospective cross-sectional study was conducted. The clinical data of 110 patients with aortic arch disease who underwent TEVAR using diode laser in situ fenestration in the Ninth People′s Hospital of Shanghai Jiaotong University School of Medicine from January 2014 to June 2017 were collected. TEVAR using diode laser in situ fenestration was performed according to the lesion involving the three branches of aortic arch. Observation indicators: (1) surgical and intraoperative situations; (2) follow-up. All patients were followed up by outpatient examination, inpatient examination and telephone interview up to May 2017. CT angiography was performed to evaluate the patency of the stents and presence of endoleak at 3, 6, and 12 months postoperatively. Measurement data with normal distribution were represented as ±s. Results (1) Surgical and intraoperative situations: 106 of 110 patients underwent successful TEVAR using diode laser in situ fenestration. Intraoperative digital subtraction angiography (DSA) showed that primary aortic dissection incisions were completely closed, with a patency of all stents and no fenestration-related endoleaks. The surgical success rate was 96.36% (106/110). Two patients died of intraoperative pericardial tamponade and 2 received chimney stent implantation after complex anatomic configuration of the aortic arch inducing to failure of the innominate artery fenestration. Of 106 patients, 70 received left subclavian arterial fenestration, 30 received 3 aortic branches fenestration and 6 received both left subclavian arterial and left common carotid arterial fenestrations. The operation time and dose of contrast agent in 110 patients were respectively (140±9)minutes and (185±5)mL. Four patients had postoperative complications, 1 died of severe pulmonary infection and 3 with cerebral infarction were improved by anti-platelet, brain nerve nutrition and other symptomatic treatment. Other patients had no transient ischemic attack, stroke, brain infarction, myocardial infarction or other neurological complications. Duration of hospital stay of the 110 patients was (15 ± 7)days. (2) Follow-up: 99 of 107 patients were followed up for 2-17 months, with a median time of 10 months. During the follow-up, there were patencies of all stents, and endoleaks of 4 patients occurred and were closely followed up and observed. Conclusion The diode laser in situ fenestration is safe and feasible in the TEVAR for the treatment of aortic arch disease, with satisfactory short-term outcomes. Key words: Aortic dissection; Aortic aneurysm; Aortic arch; Thoracic endovascular aortic repair; In situ fenestration, diode laser