Comparative Effectiveness and Safety of Laser, Needle, and "quick Fenestrater" in Fenestration During Thoracic Endovascular Aortic Repair

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2023 Oct 16

PMID 37840961

Authors

Xiaokai Wang

Jianjin Wu

Kangkang Zhi

Sili Zou

Jie Jin

Jun Bai

Lefeng Qu

Affiliations

Soon will be listed here.

Abstract

Background: Special instruments are needed for the revascularization of aortic branches in fenestration during thoracic endovascular aortic repair (TEVAR). This prospective study compared the effectiveness and safety of three currently used fenestraters: laser, needle, and Quick Fenestrater (QF).

Methods: In all, 101 patients who underwent TEVAR for aortic disease (dissection, = 62; aneurysm, = 16, or ulcer, = 23) were enrolled. All patients were randomly assigned to three groups: 34 were assigned to laser fenestration, 36 to needle fenestration, and 31 to QF fenestration. The epidemiological data, treatment, imaging findings, and follow-up outcomes were analyzed using data from the medical records.

Results: The technical success rates of the laser, needle, and QF fenestration groups were 94.1%, 94.4%, and 100% ( > 0.05). After correction of mixed factors such as age and gender, it was showed the average operative time (Laser group: 130.01 ± 9.36 min/ Needle group: 149.80 ± 10.18 min vs. QF group: 101.10 ± 6.75 min, < 0.001), fluoroscopy time (Laser group: 30.16 ± 9.81 min/ Needle group: 40.20 ± 9.91 min vs. QF group: 19.91 ± 5.42 min, < 0.001), fenestration time (Laser group 5.50 ± 3.10 min / Needle group 3.50 ± 1.50 min vs. QF group 0.67 ± 0.06 min, < 0.001), and guide wire passage time after fenestration (Laser group 5.10 ± 1.70 min / Needle group 4.28 ± 1.60 min vs. QF group 0.07 ± 0.01 min, < 0.001) were all shorter with QF fenestration than with the other two tools. The overall perioperative complication rates of the laser, needle, and QF fenestration groups were 5.9%, 5.6%, and 0% (p > 0.05): One case of sheath thermal injury and one case of vertebral artery ischemia occurred in the laser fenestration group; one case each of access site hematoma and brachial artery thrombosis were reported in the needle fenestration group. 89 (88.1%, 89/101) patients were followed for a median of 12.6 ± 1.6 months. The overall postoperative complication rates of the laser, needle, and QF fenestration groups were 3.3%, 6.5%, and 0% (p > 0.05): In the laser fenestration group, there was one death due to postoperative ST-segment elevation myocardial infarction; in the needle fenestration group, one patient developed occlusion of the bridge stent; no complications occurred in the QF group.

Conclusion: All three fenestration methods were effective in reconstructing supra-arch artery during TEVAR. QF fenestration required less contrast agent, with a shorter surgery duration and fewer complications than laser and needle fenestration.

Citing Articles

Left subclavian artery bridging stent fracture after in-situ laser fenestration during emergent thoracic endovascular aortic repair.

Racyte A, Arzola L, Wanhainen A, Asciutto G, Kuzniar M, Mani K J Vasc Surg Cases Innov Tech. 2024; 10(5):101550.

PMID: 39069993 PMC: 11277743. DOI: 10.1016/j.jvscit.2024.101550.

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