Single-fenestrated TEVAR for distal aortic arch pathologies using the Zenith® platform: a scoping review

Single-fenestrated thoracic endovascular aortic repair (1f-TEVAR) using custom-made devices (CMDs) has emerged as a less invasive strategy for managing distal aortic arch diseases.

A scoping review was conducted to identify studies reporting clinical outcomes of 1f-TEVAR with fenestration for the left subclavian artery (LSA) or left common carotid artery (LCCA), with or without a proximal scallop for the innominate artery (IA), were included.

Five studies were included, comprising 207 patients. The target vessel was most frequently the LSA, with LCCA fenestrations less common and often combined with an IA scallop. Carotid-subclavian bypass or transposition was performed in ~20-30% of patients, when the fenestration targeted the LCCA. Technical success ranged from 93% to 100%, with failures largely due to difficulties in fenestration catheterization, bridging stent deployment in angulated arches, or device malrotation. Early mortality ranged from 0% to 8%, stroke rates from 0% to 6%, type Ia endoleaks occurred in up to 7%, and target-vessel patency exceeded 95%.

1f-TEVAR using the Zenith^® platform is a feasible strategy for selected patients with distal aortic arch disease, achieving high technical success and durable target-vessel patency with acceptable early mortality. Stroke risk appears higher with LCCA fenestration, highlighting the importance of target vessel selection. Larger multicenter registries and prospective studies are needed to establish standardized indications, long-term durability, and the role of 1f-TEVAR among alternative arch repair strategies.