Laser assisted endovascular aortic intervention
Micheal T. Ayad, MD1, Derek Neiber, MD1, Richard Pin, MD2, David L. Gillespie, MD2.
1Mount Sinai Medical Center, Miami Beach, FL, USA, 2Southcoast Health System, Fall River, MA, USA.
Objective:
One of the novel and increasingly utilized methods for endovascular aortic intervention to adapt to disease processes and/or patient’s anatomy is utilizing the laser technology to create fenestration in the endograft. This is done to allow a minimally invasive solution for a usually complex situation. The more reported laser fenestration application is to allow for SCA revascularization during TEVAR. We report a series of cases on laser utilization for a spectrum of endovascular aortic intervention.
Method:
Five patients underwent endovascular aortic repair for a variety of pathologies. Two patients had laser fenestration and stent graft placement of a TEVAR graft for acute revascularization of the left SCA after suffering acute symptomatic thoracic aortic dissection with aneurysmal degeneration to obtain a successful seal. One patient presented 3 years after having TEVAR for Type B aortic dissection, which covered her left SCA in the process. She presented with symptomatic subclavian steal syndrome. She had a successful laser-assisted revascularization of the chronic subclavian artery occlusion as well as laser fenestration of the TEVAR and stent graft placement. One patient had a large type II endoleak after EVAR with expansion of the aneurysm sac. He had laser fenestration of the aortic graft limb with coil embolization of the feeding aortic branch and relining the endograft with another graft limb. The last patient had a fenestrated EVAR with the contralateral iliac limb deployed behind the main body graft. Laser was used to fenestrate through the mal-positioned limb into the true iliac lumen with correct cannulation of the endograft gate and deployment of a new endograft limb to revascularize the lower extremity.
Result:
All 5 cases were technically successful. The first 3 patients have a patent left subclavian artery at 10, 14 and 6 months respectively. The fourth patient has successful exclusion of the AAA with resolution of the endoleak and decreased aneurysm size at 12 months postoperatively. The last patient has a patent graft limb with palpable pulses of the left extremity at 10 months post intervention.
Conclusion:
Application of laser fenestration of endograft repair of abdominal and thoracic aorta can be performed safely with technical success. The results are promising on short to medium term follow up. Longer term follow up is still lacking at this time.
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