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

Area of Science:

• Vascular Surgery
• Endovascular Techniques
• Aortic Arch Repair

Background:

• Single-fenestrated thoracic endovascular aortic repair (1f-TEVAR) offers a less invasive approach for distal aortic arch diseases.
• Custom-made devices (CMDs) are utilized in 1f-TEVAR procedures.

Purpose of the Study:

• To review clinical outcomes of 1f-TEVAR with fenestration for the left subclavian artery (LSA) or left common carotid artery (LCCA).
• To assess the feasibility and safety of 1f-TEVAR in managing distal aortic arch pathologies.

Main Methods:

• A scoping review identified studies reporting outcomes of 1f-TEVAR.
• Included studies focused on fenestrations for LSA or LCCA, with or without an innominate artery (IA) scallop.

Main Results:

• Five studies involving 207 patients were analyzed.
• Technical success rates ranged from 93% to 100%, with high target-vessel patency (>95%).
• Early mortality was 0-8%, stroke rates 0-6%, and type Ia endoleaks up to 7%.

Conclusions:

• 1f-TEVAR with the Zenith® platform is a viable strategy for selected distal aortic arch disease patients.
• Stroke risk is higher with LCCA fenestration, emphasizing the need for careful target vessel selection.
• Further multicenter studies are required to define standardized indications and long-term outcomes.