Thoracic Endovascular Aortic Repair with Left Subclavian Artery Revascularization for Type B Aortic Dissection: Outcomes of Fenestrated Physician-Modified Stent-Graft Versus Unibody Single-Branched Stent-Graft.

BACKGROUND

To evaluate the outcomes of thoracic endovascular aortic repair (TEVAR) with fenestrated physician-modified stent-grafts (f-PMSG) or Castor unibody single-branched stent-graft to revascularize left subclavian artery (LSA) in type B aortic dissection (TBAD) patients.

METHODS

A retrospective analysis was conducted of TBAD patients treated f-PMSG (n = 37) or Castor unibody single-branched stent-graft (n = 43) from January 2019 to July 2022. The primary endpoints at 30 days and during follow-up were overall mortality, aortic-related mortality, and major complications. The secondary endpoints were endoleak, reintervention, and branch artery patency.

RESULTS

Technical success was 100% in both groups. No patient had early mortality in f-PMSG group, and 1 (2.3%) patient died of multiorgan failure during hospitalization in Castor group. The median follow-up was 53.6 months (range, 34-60 mouths) and 41 months (range, 24-42 months) in f-PMSG and Castor group, respectively. In f-PMSG group, 4 (10.8%) patients died, including 1 aortic-related mortality. In Castor group, 4 (9.3%) patients died of unknown reason. At 1 year after the operation, the branch artery patency rate was 92.0% and 88.4% in f-PMSG and Castor group, respectively.

CONCLUSION

For patients with TBAD, TEVAR with Castor single-branched stent-graft or f-PMSG is optimal treatment option when proximal landing zone is insufficient. Compared with f-PMSG, Castor single-branched stent-graft was an off-the-shelf product indicated for TBAD and revascularization.