Use of fenestrated stent grafts in treatment of acute aortic syndrome.

Abstract

Objective: To study the possibility and determine the safety of using stent grafts with on table and in situ fenestration in patients with acute aortic syndrome.

Patients and methods: From 2019 to 2021, specialists of the Republican Cardiological Center (Ufa) retrospectively analyzed the results of endovascular treatment of 34 patients with acute aortic syndrome.

Results and discussion: All 34 patients were operated on within the first 48 hours after the disease was detected. They were subjected to various types of endovascular debranching. In 26 patients, zone 2 according to Ishimaru was selected with on table or in situ TEVAR (Thoracic Endovascular Aortic Repair) of the left subclavian artery; in 6 cases, double fenestration of the left common carotid and left subclavian arteries were performed during implantation into zone 1 according to Ishimaru. In 2 cases, total endovascular debranching was performed during implantation into zone 0 according to Ishimaru. The average operation time was 137.35±61.4 minutes, the average contrast consumption was 295.2±79.2 ml, and the average volume of blood loss was 78±121.1 ml. In all cases, the technical success was 100%, however, during the control MSCT, 2 cases of type 3 endoleaks were identified, which were further embolized. One patient developed retrograde dissection of the ascending aorta and the aortic arch 2 months after surgery. Further surgical correction was performed. Overall in-hospital mortality was 0%, and only 3 (8.8%) patients died in the remote period.

Conclusion: Thoracic endovascular aortic repair (TEVAR) of the aortic arch with various types of endovascular debranching can be considered as an alternative and effective method for treatment of patients with acute aortic syndrome.