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In situ fenestration in the aortic arch
Brian J Manning1, Krassi Ivancev, Peter L Harris
1University College London and University College London Hospital, 235 Euston Road, London NW1 2BU, England. brianjmanning@gmail.com
Journal of Vascular Surgery
|November 3, 2009
Summary
This study presents a novel technique for in situ fenestration of aortic stent grafts, enabling successful left subclavian artery access despite challenging anatomy. The method overcomes angulation issues in aortic arch aneurysm repair.
Area of Science:
- Vascular Surgery
- Endovascular Techniques
- Aortic Aneurysm Repair
Background:
- In situ fenestration of aortic stent grafts offers a less invasive approach for maintaining supra-aortic vessel perfusion.
- Angulation of target vessels, particularly the left subclavian artery (LSA), presents a significant challenge to this endovascular technique.
Observation:
- A case involving an aortic arch aneurysm necessitated endovascular stent graft repair with fenestration of the LSA.
- The standard fenestration technique was hindered by the acute angle of the LSA take-off from the aortic arch.
Findings:
- A novel technique utilizing through-and-through wire access and a pre-curved semi-rigid sheath was successfully employed.
- This approach facilitated precise access into the aortic stent graft lumen, enabling fenestration of the acutely angled LSA.
Implications:
- This technique potentially expands the applicability of in situ fenestration for complex aortic arch pathologies.
- It offers an alternative to traditional bypass methods, improving patient outcomes and reducing device customization needs.
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