Complete Neck Vessels Preservation During Tevar Using Fenestrated Stent Graft for the Treatment of Saccular and Dissecting Arch Aneurysms

Abstract

Introduction: Coverage of the left carotid artery or the left subclavian artery (LSA) with branch vessel bypass allows for increased utilization of thoracic endovascular aortic repair (TEVAR) in patients with a short proximal landing zone. TEVAR using fenestrated stent graft in the aortic arch could achieve a better sealing zone while preserving branch flow. We report the early and mid-term results of complete neck vessels preservation during TEVAR using the Najuta fenestrated stent graft for saccular and dissecting arch aneurysm, and describe its clinical usefulness and limitations. Methods: From April 2015 to March 2019, 146 TEVARs, including 50 Najuta fenestrated TEVARs were performed in our facility. We retrospectively analyzed 17 patients treated with complete neck vessels preservation using the Najuta stent graft for saccular and dissecting arch aneurysms. Fusiform aneurysms were excluded from this analysis. Results: Patients were predominantly male (76%), with a mean age of 73 years. Thoracic aortic aneurysms were saccular in 8 cases and dissecting in 9. Mean operative time was 137 minutes. The stent graft was landed in zone 0 in 8 cases, in zone 1 in 3 cases, and in zone 2 in 6 cases. Technical success was 100% with no 30-day mortality and no major aortic event. Mean length of proximal neck were 19.7mm in saccular aneurysm, 21mm in dissecting aneurysm. Postoperative LSA occlusion was encountered in one patient (5.9%) which was treated conservatively because it was asymptomatic. Type 1 endoleak was found in one patient (5.9%). No stroke, paraplegia and retrograde aortic dissection were encountered. During a median follow up of 8 months, no conversion to open surgical repair and no aortic rupture occurred. Conclusion: Although careful case selection is necessary, complete neck vessels preservation during TEVAR using the Najuta fenestrated stent graft appears to be a safe and effective treatment. This strategy also decreases need for branch vessel bypass. [Preoperative CT] [Postoperative CT] Disclosure: Nothing to disclose