Surgeon-modified fenestrated stent graft deployment in type B aortic dissection

Area of Science:

• Vascular Surgery
• Cardiovascular Surgery
• Endovascular Interventions

Background:

• Thoracic endovascular aortic repair (TEVAR) is a primary treatment for descending aortic pathologies.
• Left subclavian artery (LSA) coverage is frequently necessary for adequate proximal landing zones in TEVAR.
• While LSA coverage is often tolerated, revascularization is preferred to mitigate risks of stroke or ischemia.

Purpose of the Study:

• To present a novel surgical technique for managing type B aortic dissection.
• To describe the application of a surgeon-modified fenestrated stent graft in TEVAR.
• To address the challenge of LSA coverage during TEVAR.

Main Methods:

• A type B aortic dissection patient underwent TEVAR.
• A surgeon-modified fenestrated stent graft was utilized.
• The technique involved creating a fenestration to preserve LSA patency.

Main Results:

• The modified stent graft allowed for a suitable proximal landing zone.
• The fenestration successfully maintained perfusion to the left subclavian artery.
• The procedure aimed to reduce the risk of neurological and ischemic complications.

Conclusions:

• Surgeon-modified fenestrated stent grafts are a viable option for TEVAR in complex aortic dissections.
• This technique may offer an alternative to LSA coverage or more complex hybrid procedures.
• Further investigation is warranted to evaluate long-term outcomes.