Endovascular aortic arch repair with a pre-cannulated double-fenestrated physician-modified stent graft: a benchtop experiment. (26th May 2021)

• Record Type: Journal Article
• Authors: Lounes, Youcef; Chassin-Trubert, Lucien; Gandet, Thomas; Ozdemir, Baris Ata; Peyron, Antoine; Akodad, Mariama; Alric, Pierre; Canaud, Ludovic
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 32:Number 6(2021)
• Page Start: 942
• Page End: 949
• Publication Date: 2021-05-26
• Subjects: Aortic arch -- Aorta -- Physician modified stent grafts -- Thoracic endovascular aortic repair -- Experimental; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivab023
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: : OBJECTIVES: The critical step in total endovascular aortic arch repair is to ensure alignment of fenestrations with, and thus maintenance of flow to, supra-aortic trunks. This experimental study evaluates the feasibility and accuracy of a double-fenestrated physician-modified endovascular graft [single common large fenestration for the brachiocephalic trunk and left common carotid artery and a distal small fenestration for left subclavian artery (LSA) with a preloaded guidewire for the LSA] for total endovascular aortic arch repair. METHODS: Eight fresh human cadaveric thoracic aortas were harvested. Thoracic endografts with a physician-modified double fenestration were deployed for total endovascular aortic arch repair in a bench test model. A guidewire was preloaded through the distal fenestration for the LSA. All experiments were undertaken in a hybrid room under fluoroscopic guidance with subsequent angioscopy and open evaluation for assessment. RESULTS: Mean aortic diameter in zone 0 was 31.3 ± 3.33 mm. Mean duration for stent graft modification was 20.1 ± 5.8 min. Mean duration of the procedure was 24 ± 8.6 min. The Medtronic Valiant Captivia stent graft was used in 6 and the Cook Alpha Zenith thoracic stent graft in 2 cases. LSA catheterization was technically successful with supra-aortic trunk patency in 100% of cases. CONCLUSIONS: The use of a double-fenestrated stent graft with a preloaded guidewire appears to be a useful technical addition to facilitate easy and correct alignment of stent graft fenestrations with supra-aortic trunk origins.