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4 . 2022

Total arch TEVAR with outside (on-a-table) and in situ fenestration (F-TEVAR): first results

Abstract

Background. Over the past 20 years, there has been a clear shift towards endovascular repair of the thoracic aorta in its various pathologies. However, complete endovascular repair of the aortic arch remains technically sophisticated. Currently, there are several methods of endovascular arch treatment: a hybrid approach, total endovascular debranching using parallel grafts (like a chimney or snorkeling) and fenestration (factory-made, hand-made (physician modified graft [PMG]) in-situ or outside [on-a-table]). The first results of the application of the aortic arch repair technology are promising, especially the complete replacement of the aortic arch by means of non-standard fenestrated or branched stent grafts.

Use of fenestrated or branched grafts factory FTEVAR and Chimney is an attractive method for treating aortic arch diseases but they have higher cost and longer waiting time.

Aim. To improve the outcome of surgical treatment of patients with aortic arch pathology.

We introduce for your consideration several cases of hybrid endovascular repair of the total aortic arch and side-branches in patients with type A aortic dissection (according to Stanford classification) using the “outside”(on-a-table) and “in-situ” techniques of graft fenestration, as well as first demonstrate the long-term results of the Russian Federation.

Keywords:aortic dissection; outside and in situ; fenestration; aortic arch; total arch; stent-graft; FTEVAR; TEVAR; physician modified graft (PMG)

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Akhmedov U.U., Sharafutdinov M.R., Yakubov R.A., Sadykov R.Z., Khayrutdinov A.I., Tarasov Yu.V., Mukhamadeev M.F. Total arch TEVAR with outside (on-a-table) and in situ fenestration (F-TEVAR): first results. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (4): 12–5. DOI: https://doi.org/10.33029/2308-1198-2022-10-4-12-15  (in Russian)

References

1.     Patel H.J., Nguyen C., Diener A.C., et al. Open arch reconstruction in the endovascular era: analysis of 721 patients over 17 years. J Thorac Cardiovasc Surg. 2011; 141: 1417.

2.     Zhang J., Liu X., Tian M., et al. Endovascular aortic repairs combined with looping-chimney technique for repairing aortic arch lesions and reconstructing left common carotid artery. J Thorac Dis. 2020; 12 (5): 2270–9. DOI: https://doi.org/10.21037/jtd.2020.04.31  

3.     Glorion M., Coscas R., McWilliams R.G., et al. A comprehensive review of in situ fenestration of fortic endografts. Eur J Vasc Endovasc Surg. 2016; 52 (6): 787–800. DOI: https://doi.org/10.1016/j.ejvs.2016.10.001  

4.     Makaloski V., Tsilimparis N., Rohlffs F., et al. Endovascular total arch replacement techniques and early results. Ann Cardiothorac Surg. 2018; 7 (3): 380–8. DOI: https://doi.org/10.21037/acs.2018.04.02  

5.     Shu C., Fan B., Luo M., et al. Endovascular treatment for aortic arch pathologies: chimney, on-the-table fenestration, and in-situ fenestration techniques. J Thorac Dis. 2020; 12 (4): 1437–48. DOI: https://doi.org/10.21037/jtd.2020.03.10

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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