Abstract
Background: The distance from the left subclavian artery (LSA) to the entry tear may create challenges for endovascular repair technique in type B thoracic aortic dissection. A modified technique, fenestrated stent grafting, to extend the proximal landing zone could be effective in some typical cases. Method: From January 2020 to May 2021, 21 patients underwent fenestrated thoracic endovascular aortic repair (f-TEVAR). The pathologies including descending aortic intramural haemorrhage (4 cases), penetrating aortic ulcers (3 cases) and acute type B thoracic aortic dissection (TBAD) (14 cases) with shortness of proximal landing zone. Medical history, medical records, computed tomography scan and angiograms were reviewed in detail. All patients were underwent 3 months follow medical check up. Result: The average age of patients was 61.4 years (range 45 – 79) and 16 of them were man. The average proximal landing zone was measured 14.67 mm (range 12 – 17) and the distance between left common carotid artery to LSCA was 8.2 mm (range 6 – 11). 21 fenestrated stentgrafts (STG) were deployed (12 Medtronic Valiant STGs and 9 Relay STGs). Successful rate of endovascular technique was 95.3% with no significant longer intervention duration. We misplaced the fenstrated hole after deployment in one case, but chimney technique was performed alternatively. No endoleak was revealed after 3 months CT scan check. None of patient developed stroke, spinal cord injury developed (SCI) in 1 case, postoperatively. The procedure-associated SCI rate was 4.7%. Conclusion: The successful rate of f-TEVAR technique was 95.3% and maintaining good LSA blood flow. The incidence of stroke was none and postoperative SCI was 4.7% and recovered. f-TEVAR can be safely applied in acute TBAD and descending aortic lesions with shortness of proximal landing zone.
