AUTHOR=Shen Peier , Li Donglin , Wu Ziheng , He Yangyan , Wang Xiaohui , Shang Tao , Zhu Qianqian , Tian Lu , Li Zhenjiang , Zhang Hongkun 

TITLE=Physician-modified fenestration or in situ fenestration for preservation of isolated left vertebral artery in thoracic endovascular aortic repair

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1055549

DOI=10.3389/fcvm.2023.1055549

ISSN=2297-055X

ABSTRACT=<sec><title>Objective</title><p>To present our experience of preserving the isolated left vertebral artery (ILVA) with physician-modified fenestration (PM-F) or <italic>in situ</italic> fenestration (ISF) during thoracic endovascular aortic repair (TEVAR) for aortic pathologies involving aortic arch.</p></sec><sec><title>Methods</title><p>This is a single-center, retrospective, observational cohort study. Between June 2016 and December 2021, 9 patients (8 men; median age 60.0 years old) underwent TEVAR with ILVA reconstruction (PM-F, <italic>n</italic> = 6; ISF, <italic>n</italic> = 3) were identified and analyzed.</p></sec><sec><title>Results</title><p>The technical success rate was 100%. No early (&lt;30 days) death occurred. No aortic rupture, major stroke or spinal cord injury was observed. The median follow up was 38.0 (rang: 1.0–66.0) months. One death occurred at 56 months, while the reason cannot be identified. No aortic rupture, major stroke or spinal cord injury was observed during follow up. No patient required reintervention. Out of the 22 successfully revascularized target vessels, 2 ILVAs were found occluded in 2 patients at 6 months and 7 months, respectively. However, these two patients were asymptomatic.</p></sec><sec><title>Conclusions</title><p>Our initial experience reveals that PM-F or ISF for ILVA preservation was feasible, safe, and effective during TEVAR for complex thoracic aortic pathologies. However, the patency of preserved ILVA should be improved.</p></sec>