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Published on: August 1, 2025
Physician-Modified Endovascular Grafts for Zone-2 Thoracic Endovascular Aortic Repair
André B Queiroz1,2, Jackson B Lopes1, Vanessa P Santos2
1Centro de Doenças da Aorta - CDA, Division of Vascular and Endovascular Surgery, Cardiac Surgery, Cardiology and Anesthesia, Universidade Federal da Bahia, Hospital Ana Nery, Salvador-Bahia, Brazil.
Objective:
This study aims to describe our technique and early experience with physician-modified endovascular grafts (PMEGs) for aortic arch diseases in zone 2. We used a total endovascular technique based on a single fenestrated endograft to preserve left subclavian artery (LSA) patency.
Methods:
From December 2019 to August 2020, six consecutive patients with a variety of thoracic aortic diseases were treated with handmade fenestrated thoracic aortic grafts: four aortic dissections, one penetrating aortic ulcer, and one intramural hematoma. The planning, endograft modification, surgical technique, and follow-up of the patients were described. We evaluated immediate technical success and after 30 days, the LSA patency, Type-1 endoleak, and postoperative complications.
Results:
Thoracic endovascular aortic repair (TEVAR) was performed for zone 2 in all cases. Immediate technical success, defined as successful alignment of the LSA with a covered stent and no Type-1 endoleak, was achieved in all cases. Patients had a 30-day follow-up computed tomography, which demonstrated LSA patency and no Type-I endoleaks. To date, no strokes, left arm ischemia, paraplegia, or conversions to open surgery have been reported; one patient operated for acute Type B dissection died during the early follow-up.
Conclusion:
TEVAR for zone 2 with a PMEG to maintain LSA patency achieved technical success and early durability. It is expected that with longer follow-up and a larger number of cases, these results will be confirmed.
