Thoracic Endovascular Aortic Repair Using Combined the Najuta Fenestrated Stent Graft Plus the Distal Ctag Stent Graft for Aortic Arch Aneurysm

Abstract

Introduction - The Najuta fenestrated stent graft extend the proximal sealing zone during thoracic endovascular aortic repair (TEVAR). On the other hand, the CTAG stent graft has good conformability in the inner curvature of the aortic arch and has a less spring-back force of the stent graft. Based on these strength, we used the Najuta fenestrated graft for proximal fixation while the CTAG was used for distal landing for TEVAR of aortic arch in high-risk patients. We report the early results of this combined strategy. Methods - From January 2015 to March 2018, 117 TEVARs were performed in our facility. 16 patients (94% male; mean age 75 years) treated with combined the Najuta plus the CTAG stent graft. Results -TAA were fusiform in 7 cases, saccular in 4, dissecting in 4, and 1 patient was treated for proximal type 1 endoleak after previous TEVAR. The stent graft was landed in zone 0 in 13 cases, in zone 1 in 3 cases. The Najuta custom made fenestration was designed to preserve flow in the left common carotid artery in 11 patients, in the left subclavian artery in 2. There were 10 cases (63%) in which we could avoid the debranching bypass. No proximal type 1 endoleak occurred and proximal sealing was achieved in all cases. Technical success was 100% with no 30-day mortality. Mean operative time was 185 minutes. All targeted vessels were patent. One stroke occurred with TEVAR landing in zone 0 with an overall stroke rate of 6%. No paraplegia and retrograde dissection were encountered. During a mean follow up of 12 months, no conversion to open surgical repair and no aortic rupture occurred. Conclusion - Combined proximal Najuta and distal CTAG stent grafting appears to be a safe and effective treatment. This strategy also decreases the need for debranching bypass procedures.