Early Experience and Lessons Learnt with Customized Fenestrated Thoracic Endovascular Aortic Reconstruction for Aortic Arch Pathology in an Asian Population.

Purpose: Thoracic endovascular aortic repair (TEVAR) is the preferred treatment of descending thoracic aorta pathology. However, TEVAR in the aortic arch remains challenging. Customized fenestrated TEVAR (fTEVAR) allows extension of the proximal seal zone, while preserving the involved supra-aortic vessels. There is a paucity of information on fTEVAR; hence, we aim to evaluate our early experience and lessons learnt with fTEVAR in the aortic arch.

Methods: This is a retrospective single-centre review of fTEVAR endografts for aortic arch pathology over 24 months. Seven patients with mean age of 72.8 years (range 63-84 years) were included. A total of 15 supra-aortic branches were treated [left subclavian artery (n = 7), left carotid artery (n = 5), innominate artery (n = 1), bovine origins (n = 2)], involving a total of nine fenestrations and six scallops. No supra-aortic debranching was required.

Results: Median follow-up was 15 months. Technical success was 86%, and one patient had malalignment of the fTEVAR endograft requiring salvage with double chimney technique. There were no early endoleaks with one type 2 endoleak detected in the follow-up period. Two access site pseudoaneurysms required intervention. There was a learning curve involved reflected by higher than average mean operative time of 224 min with average radiation dose of 3029.86 mGy and mean contrast volume of 283 mls.

Conclusion: fTEVAR in the aortic arch is feasible in Asian patients, although there was a learning curve involved, and careful patient selection is advised. Longer term data in a larger population are required to assess its durability.