Outcomes of thoracic endovascular aortic repair with fenestrated surgeon-modified stent-grafts for type B aortic dissection involving the aortic arch: a multicenter retrospective study.

BACKGROUND

Thoracic endovascular aortic repair (TEVAR) with fenestrated surgeon-modified stent-grafts (f-SMSGs) is becoming an option for treating type B aortic dissection (TBAD) involving the aortic arch. This study aimed to evaluate the outcomes of this technique.

METHODS

A retrospective multicenter study was conducted, involving consecutive patients from three medical centers in China who underwent TEVAR with f-SMSG for TBAD. A new technique called "Lu's direction-turnover technique" was employed to align the fenestrations with supra-aortic vessels.

RESULTS

From March 2016 to January 2020, 117 patients diagnosed with TBAD were deemed eligible for inclusion. The technical success rate was 94% (n=110). The estimated 30-day survival rate was 97.4% [95% confidence interval (CI): 94.5% to 100.0%], with freedom from re-intervention estimated at 95.7% (95% CI: 92.0% to 99.4%). The median follow-up period was 27 months (interquartile range, 19 to 35 months). The estimated survival rate at 27 months was 94.9% (95% CI: 90.8% to 98.9%) and the rate of freedom from re-intervention was 91.5% (95% CI: 86.3% to 96.6%). Cases of retrograde type A aortic dissection, stroke and endoleaks were documented. Five cases of retrograde type A aortic dissection were documented, with three occurring within 30 days and one during the follow-up. Four cases of stroke were recorded, with one occurring within 30 days and three during the follow-up. Furthermore, eleven cases of endoleaks were recorded, with one occurring within 30 days and ten during the follow-up.

CONCLUSIONS

Clinically acceptable technical success and prognosis were observed in a cohort with TEVAR with f-SMSG for the treatment of TBAD involving the aortic arch, which necessitated revascularization of the supra-aortic vessels. Further comparative studies are required to validate the benefits of this approach.