Back to 2025 Karmody Posters
In Situ Laser Fenestration For Zone 2 Tevar: A 15 Year Experience Demonstrating Its Safety, Efficacy And Durability
William Montgomery, MS
1, Fletcher Pierce
1, Ahmad Alsheekh, MD
1, Fanny Allie-Cusson, MD
2, Hosam F. El Sayed, MD
1, Jean M. Panneton, MD
1.
1Eastern Virginia Medical School, Norfolk, VA, USA,
2Atrium Health, Charlotte, NC, USA.
Objectives: In situ laser fenestration (ISLF) of the left subclavian artery (LSA) is a simple and effective method for revascularization, but long-term outcome data for this technique are lacking. This study aims to evaluate long-term outcomes of ISLF of the LSA in zone 2 thoracic endovascular aortic repair (TEVAR).
Methods: A single-center retrospective review of all consecutive patients who underwent zone 2 TEVAR with LSA revascularization by ISLF was performed (2009-2024). This technique was performed through retrograde percutaneous or open brachial arterial access. A thoracic endograft was deployed in zone 2 followed by ISLF using a 2.3 mm laser. A balloon expandable covered stent was deployed across the fenestration and post-dilated. Primary outcome was fenestration-related endoleaks (type Ic or IIIc). Secondary outcomes were stroke rate, LSA stent patency, freedom from fenestration-related endoleak reintervention, fenestration-related mortality (FRM) and aortic-related mortality (ARM).
Results: 81 patients were included in our series (mean age 60.9 ±12.8 years). Indication for intervention was type B aortic dissection in 67 patients (82.7%). 92% of all interventions were urgent or emergent, with 19 patients presenting with rupture (23.5%). Median operative time was 153 minutes. Stroke occurred in 3 patients (3.7%) and spinal cord injury in 6 patients (7.4%, 3 transient, 3 permanent). There were five (6.2%) 30-day operative mortalities. Median clinical follow-up was 2.1 years (range 0-12.6]) and median imaging follow-up was 2.6 years (range 0-12.5). 3 patients (3.7%) were found to have a type 1c endoleak and underwent distal extension of the LSA stent at 6.6, 23.6, and 30.2 months. LSA stent primary patency was 100% at 1 year, 96.7% at 5 years and 91.1% at 10 years (Figure 1A). Freedom from fenestration-related endoleak reintervention was 98.4% at 1-year, 93.2% at 5 years and 93.2% at 10 years (Figure 1B). There was only 1 ARM (1.4%) and no FRM.
Conclusions: ISLF has an excellent technical success rate, low stroke rate and low fenestration-related complications, and competitive long-term stent patency. ISLF for LSA revascularization is a safe, effective, and durable option for zone 2 TEVAR.
Back to 2025 Karmody Posters
