Precision alignment in minimalist fenestrated thoracic endovascular aortic repair: a novel physician-modified technique involving self-aligning Relay nonbare stent grafts for thoracic aortic endovascular repair.

BACKGROUND

Thoracic aortic fenestration is one of the methods employed for aortic arch reconstruction. To address the technical complexities of conventional fenestrated thoracic endovascular aortic repair (f-TEVAR) for aortic diseases involving the arch, we developed a streamlined approach using a novel physician-modified Relay nonbare stent graft (Terumo Aortic), eliminating the need for time-consuming marker suturing or guidewire-assisted fenestration alignment. This study evaluated the clinical application of this minimalist modification protocol.

METHODS

This retrospective cohort study analyzed 33 patients undergoing minimalist f-TEVAR with Relay nonbare stent-grafts between January 2023 and December 2023 in Beijing Anzhen Hospital, with precise preoperative electrocardiography-gated, computed tomography angiography-guided fenestration planning being applied. The stent graft's proprietary self-alignment mechanism enabled marker-free orientation via its precurved design and 12/6 o'clock markers. Intraoperative modifications included partial deployment, low-temperature fenestration punching, and simplified resheathing with dual-layer delivery. The primary endpoints were technical success, stent-graft modification time, fluoroscopy time, procedure time, endoleak rate, procedure-related complications, length of stay, and 30-day and late mortality.

RESULTS

The cohort (mean age 63.2±10.6 years; 75.8% male) comprised patients with variety of aortic diseases, including penetrating ulcers (42.4%), type-B dissections (27.3%), non-A non-B dissections (18.2%), and aneurysms (12.1%). The modified protocol proved to be efficient : the graft modification time was 6.8±1.8 minutes, the fluoroscopy exposure was 8.2±3.9 minutes, and the total procedure time was 57.9±13.1 minutes. All procedures achieved technical success (100%), with no instances of endoleak, retrograde dissection, or neurological complications. All patients survived after a mean follow-up of 12.6±3.7 months. Supra-arch branches were all patent by the end of follow-up.

CONCLUSIONS

Our experience demonstrates that the Relay nonbare stent-graft self-aligning design enables safe and efficient fenestration while maintaining excellent sealing properties and branch vessel patency. This stent-graft selection strategy provides a reliable foundation for simplified arch repair, potentially expanding the accessibility of complex endovascular aortic interventions.