Outcomes of Surgically Assisted SDRNP for Three-Fenestration Stent Grafts in Treatment of Aortic Arch Pathologies

Thoracic endovascular aortic repair (TEVAR) has become the preferred method in the treatment of aortic arch diseases by now. Due to the complex anatomical structure and reconstruction techniques, it is difficult to perform total endovascular aortic arch treatment for patients with aortic arch lesions. Our team initiates the reconstruction of aortic arch vessels using the surgically assisted short-distance retrograde needle puncture (SDRNP) technique for three-fenestration stent grafts. This article aims to demonstrate the feasibility and safety of performing the SDRNP technique for three-fenestration stent grafts in treating aortic aneurysm, dissection, or penetrating ulcer involving the aortic arch. A retrospective review was performed on 12 patients with aortic arch diseases, who underwent surgically assisted SDRNP technique for three-fenestration stent grafts to revascularize supra-arch branches. The overall technical success rate was 100.0% (12/12). The average operative time and intraoperative bleeding were 228.5 ± 69.6 min and 74.5 ± 26.9 mL, respectively. Complications consisted of 1 stroke, 1 acute myocardial infarction, and 2 endoleaks (1 type III and 1 type I). The patient with type III endoleaks improved after coil embolization after re-intervention. There were no aorta-related deaths during the average follow-up of 10.3 ± 2.8 months. All of the bridging stents were patent, with no migration. The three-fenestration stent grafts using the surgically assisted SDRNP technique offer a great advance for the treatment of aortic arch diseases, which might be an ideal operation process for aortic arch vessels.