Total Endovascular Aortic Arch Repair Using In Situ Needle Triple Fenestration and Selective Cerebral Perfusion:...

Area of Science:

• Cardiovascular Surgery
• Interventional Radiology
• Vascular Medicine

Background:

• Thoracic endovascular aortic repair (TEVAR) indications now include aortic arch lesions.
• In situ needle fenestration (ISNF) is a novel technique for supra-aortic branch revascularization.
• Evaluating triple ISNF during TEVAR for aortic arch pathologies is crucial.

Purpose of the Study:

• To assess the safety and efficacy of triple ISNF during TEVAR for aortic arch pathologies.
• To report on a single-center experience with this advanced endovascular technique.

Main Methods:

• Retrospective analysis of 15 patients undergoing triple ISNF TEVAR (June 2023 - March 2024).
• Procedures performed under general anesthesia in a hybrid operating room.
• Data collected on technical success, complications, and outcomes.

Main Results:

• 100% primary technical success achieved in all 15 patients.
• One 30-day mortality (6.66%); one transient ischemic attack, no strokes or spinal cord ischemia.
• Eight patients required reintervention in the descending aorta; no procedure-related endoleaks.

Conclusions:

• Triple ISNF is a feasible and effective method for revascularizing aortic arch vessels during TEVAR.
• The technique demonstrates low early mortality and stroke rates when performed by experienced teams.
• Further multicenter studies with long-term follow-up are necessary to confirm durability.