Laser Fenestration in TEVAR: Perspectives and Future Directions

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• Endovascular aortic repair (EVAR) is a growing treatment for thoracic aortic diseases.
• Coverage of great vessels by thoracic endografts presents a challenge.
• Supra-aortic trunk revascularization is crucial in these cases.

Purpose of the Study:

• To evaluate the safety and efficacy of in situ laser fenestration for supra-aortic trunk revascularization during EVAR.
• To identify anatomical factors influencing the technical feasibility of laser fenestration.
• To assess short- and mid-term clinical outcomes.

Main Methods:

• In situ laser fenestration technique for creating fenestrations in thoracic endografts.
• Patient selection based on thoracic aortic pathologies and anatomy.
• Analysis of procedural success, complications, mortality, and stroke rates.

Main Results:

• In situ laser fenestration is a safe and effective option for supra-aortic trunk revascularization.
• Promising short- and mid-term outcomes regarding mortality, stroke, and complications.
• Anatomical factors like aortic arch type can increase technical challenges.

Conclusions:

• Laser fenestration is a viable solution for complex EVAR cases involving great vessel coverage.
• The technique demonstrates favorable early clinical results.
• Future advancements may broaden its applicability to more diverse and challenging patient anatomies.