Analysis of Complication of In-situ Laser Fenestration during TEVAR
Chong Li, MD.
New York University, New York, NY, USA.
Objective: To analyze and discuss complications of in-situ laser fenestration during thoracic endovascular aortic repair (TEVAR) on treatment of aortic arch pathologies.
Method: The medical records of the patients treated with TEVAR and in-situ laser fenestration of aortic arch branches at First Affiliated Hospital of Zhengzhou University from January 2017 to March 2018 were retrospectively reviewed. Pre-operative, intra-operative, peri-operative and followup data are analyzed and discussed.
Results: There were 102 patients total, 85 males and 17 females, and 21 to 79 years of age (mean 52 years). Followup duration ranges from 2 to 15 months (mean 10 months). Total number of fenestrations were 113 aortic arch vessels, with technical success in 109 (96.5%). Postoperatively, there were 6 cases of endoleaks (5.9%); retrograde dissection to the ascending aorta in 2 (2%); neurological complications in 6 patients (5.9%); hematoma in the fenestration site in 2 (2%). Peri-operative death occurred in 3 patients with 30-day mortality of 2.9%. There was no branch stent graft restenosis or occlusion during followup.
Conclusion: In-situ laser fenestration during TEVAR for treatment of aortic arch disease are safe and effective based on short-term follow-up. The choice of devices, fenestration technologies, and surgeon's experience are associated with the incidence of complications. Continued follow-up of the off-label use of laser technology during TEVAR stent graft is needed to investigate the long-term outcomes. 
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