Endovascular Repair Combine with In-situ Fenestration for New-Onset or Residual Arch Dissection in Patients Underwent Aortic Replacement

Background: Ascending aorta or hemi-arch replacement used to be a common treatment for some patients with acute type A thoracic aortic dissection especially in the elderly or complicated with multiple comorbidities. However the secondary entry tears in the aortic arch or descending aorta often remains not completely closed or true lumen compressed by perfusion of the false lumen in the dissected aorta and usually require reoperation. Methods: : From January 2019 to July 2022, eighteen patients were treated by endovascular total aortic arch repair and fenestration technique without median re-sternotomy. Aortic stent grafts were implanted from femoral approach, prosthetic vessels can be served as an adequate proximal landing zone for aortic stent graft deployment. According to the debranching conditions of the arch in the previous surgery, single, double or triple in-situ fenestrations were performed respectively. Endovascular repair of aortic arch or descending aorta and restoration of perfusion of the branch arteries were accomplished. Result: Technical success was achieved in all cases. Median follow-up was 20 (18;31) mouths. All patients had an acceptable postoperative course with no 30-day and in-hospital deaths. None of the patients showed signs of disabling stroke, paraplegia or endo-leak, stent graft migration and stent graft induced new entry. In all patients the false lumen was completely thrombosed at the aortic arch level . Conclusion: Our preliminary experience suggests that endovascular total arch repair combined with in-situ fenestration technique are feasible, effective and safe options. And mid-term result seems encouraging. However long-term result and durability concerns for further evaluation are mandatory.