Application of in situ needle puncture fenestration of left subclavian artery during thoracic endovascular aortic repair with the short proximal landing zone

Objective: To evaluate the feasibility and safety of in situ fenestration during the endograft of thoracic endovascular aortic repair (TEVAR) via the left subclavian artery (LSA). Methods: A total of 23 patients, including 17 patients with thoracic aortic dissection and 6 patients with thoracic aortic aneurysm, were respectively enrolled from October 2018 to June 2019 at Nanfang Hospital, Southern Medical University. All of the patients underwent in situ fenestration of LSA via the thoracic artery endograft following the TEVAR procedure. A 21 G preflex hollow needle was used to puncture the endograft from the medial segment of LSA for in situ feneatration. The success rate, clinical effect and complications were recorded on 1, 3 and 6 months after in situ fenestration. Results: The success rate was 100% in all the 23 patients with needle puncture in situ fenestration of LSA. The rechecked thoracic aorta angiography showed that both thoracic aortic main endograft and the LSA branch cover stent were well expanded, and there were no endoleak occurred around the LSA branch cover stent. No hematoma was found in the supraclacicular fossa within all the perioperative period. A small pneumatothorax in the left pleural cavity which did not need treatment was being detected in 1 patient on the chest film 3 days after the procedure. The mean follow-up time was (4.2 ± 1.4) months. There were no retrograde tearing happened in the proximal end of the endograft, and no endoleak happened around the LSA branch cover stent either. Conclusion: The technique of needle puncture fenestration of LSA via the thoracic artery endograft is considered as a simple, safe, and effective method of in situ LSA reconstruction. (authors)