Antegrade In Situ Laser Fenestration Technique In Complex Endovascular Aortic Repair For Symptomatic And Ruptured Pararenal/thoracoabdominal Aortic Aneurysms: A Multicenter Case Series
Callie McAdams, MD1, Robert C. Allen, MD2, Mark W. Fugate, MD3, Scott L. Stevens, MD1, Michael M. McNally, MD1.
1University of Tennessee - Knoxville, Knoxville, TN, USA, 2Ballad Health, Kingsport, TN, USA, 3CHI Memorial, Chattanooga, TN, USA.
Objective: Investigate the multicenter clinical outcomes of antegrade laser in-situ fenestration technique in complex aortic aneurysm repair for symptomatic and ruptured pararenal/thoracoabdominal aortic aneurysms.
Methods: A multicenter retrospective review of in-situ laser fenestration technique utilized for complex endovascular aortic aneurysm repair in symptomatic and ruptured aneurysm patients. All planned cases involved patients deemed too high risk for open repair and were excluded from current FDA clinical trials. Specific consent for the laser in-situ technique and off-label use of an FDA approved device was obtained. Primary outcomes examined included procedural technical success rate, perioperative complications, postoperative length of stay, secondary interventions and 30-day mortality.
Results: Between July 2019 and June 2021 at three separate institutions, 18 patients underwent in-situ laser fenestration technique in 46 visceral vessels during urgent complex endovascular repair (12 Symptomatic, 6 Rupture). Eleven patients were female (61%) with an average age of 72 years (range 43-87 years). Eight thoracoabdominal aortic aneurysms, nine pararenal aneurysms and one descending thoracic aneurysm from a type1B endoleak were repaired. Technical success was 100% for the in-situ laser fenestration technique. Two perioperative complications included one patient with transient acute kidney injury after perioperative bilateral renal artery thrombosis requiring emergency percutaneous thrombectomy and a second patient requiring open femoral artery access repair. No stroke, permanent renal failure, bowel ischemia or spinal cord ischemia was observed. Mean hospital length of stay was 4 days (range 1-14). Long term secondary interventions included TEVAR for proximal thoracic aortic dissection and type III endoleak repair. Thirty-day mortality was 11% (1 perioperative respiratory failure, 1 unrelated trauma). Median follow-up CTA imaging was 6 months (range 1-23months) with 95% visceral stent graft primary patency.
Conclusion: In-situ laser fenestration technique in complex endovascular aortic surgery is a safe, feasible option in urgent complex endovascular aortic repair. Further investigation is necessary to better evaluate endovascular aortic repair durability and stent graft patency utilizing the laser in situ technique.
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