In situ diode laser fenestration of aortic arch stent grafts during thoracic endovascular aortic repair of Stanford type A aortic dissection.

AIMS: The aim of the study was to evaluate the feasibility, safety, and effectiveness of in situ diode laser fenestration of thoracic endovascular aortic repair (TEVAR) stent grafts to treat Stanford type A aortic dissection.

METHODS AND RESULTS: Fifty-eight patients with acute or subacute Stanford type A aortic dissection treated with in situ diode laser fenestration during TEVAR under cerebral circulation protection with an extracorporeal bypass were reviewed retrospectively. Routine postoperative outcomes were recorded and assessed. Computed tomography angiography (CTA) was performed during the follow-up after 3, 6 and 12 months. Procedural success was achieved in 53 patients (91.4%). The average procedure time was 162±36 minutes. One patient died of pericardial tamponade during intervention, and one died of severe pneumonia after the intervention. Except for two minor strokes, no more fenestration-related complications occurred at 30 days and 12 months after the intervention. CTA imaging demonstrated 100% primary patency for the left subclavian artery and carotid arteries with favourable aortic remodelling after TEVAR during the follow-up. Two patients had a type Ia endoleak and one other a type II endoleak.

CONCLUSIONS: In situ diode laser fenestration during TEVAR for type A aortic dissection was found to be feasible, safe, and effective, and may be beneficial as a less invasive approach.