"J. D" technique: A method for <i>in situ</i> fenestration of left subclavian artery in thoracic endovascular aortic repair_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Jidong , YANG Wengang , GU Jianmin ,  XUE Song

Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, P.R.China;

Corresponding author：

XUE Song, Email: xuesong64@163.com

Keywords：

Thoracic endovascular aortic repair; left subclavian artery; in situ fenestration

DOI：

10.7507/1007-4848.201908040

Video：

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Objective To report a simple and safe method for in situ fenestration of left subclavian artery in thoracic endovascular aortic repair (TEVAR).Methods Twenty-eight patients received in situ fenestration of left subclavian artery in TEVAR from June 2018 to May 2019 in our center, including 23 males and 5 females at an average age of 57.7±9.6 years. Among them, 12 patients used adjustable sheath or guiding catheter (a group A) and 16 patients used "J. D"technique (a group B). The clinical efficacy of the two groups was compared.Results In the group A, 1 patient failed to receive fenestration and was transferred to the chimney technique. In the group B, 1 patient due to the traction system shift during operation, was completed by traditional adjustable sheath puncture. The group B had shorter alignment-perforation time and trigger time and less complications. There was no significant difference in endoleak during short-term follow-up between the two groups.Conclusion The "J. D" technique is simple, safe and easy to obtain materials. It effectively reduces the risk caused by difficult sheath alignment during the in situ fenestration of the left subclavian artery. Although the results of recent follow-up are not significantly different from traditional methods, it still needs to accumulate the cases to observe the possible risks and difficulties.

Citation： LIU Jidong, YANG Wengang, GU Jianmin, XUE Song. "J. D" technique: A method for in situ fenestration of left subclavian artery in thoracic endovascular aortic repair. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(4): 450-453. doi: 10.7507/1007-4848.201908040 Copy

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2.	Waterford SD, Chou D, Bombien R, et al. Left subclavian arterial coverage and stroke during thoracic aortic endografting: a systematic review. Ann Thorac Surg, 2016, 101(1): 381-389.
3.	Garg K, Maldonado TS. Further consideration for subclavian revascularization with TEVAR. Semin Vasc Surg, 2012, 25(4): 232-237.
4.	Matsumura JS, Lee WA, Mitchell RS, et al. The Society for Vascular Surgery practice guidelines: management of the left subclavian artery with thoracic endovascular aortic repair. J Vasc Surg, 2009, 50(5): 1155-1158.
5.	Zamor KC, Eskandari MK, Rodriguez HE, et al. Outcomes of thoracic endovascular aortic repair and subclavian revascularization techniques. J Am Coll Surg, 2015, 221(1): 93-100.
6.	Ahmad W, Mylonas S, Majd P, et al. A current systematic evaluation and meta-analysis of chimney graft technology in aortic arch diseases. J Vasc Surg, 2017, 66(5): 1602-1610.
7.	Bosiers MJ, Donas KP, Mangialardi N, et al. European multicenter registry for the performance of the chimney/snorkel technique in the treatment of aortic arch pathologic conditions. Ann Thorac Surg, 2016, 101(6): 2224-2230.
8.	Wang T, Shu C, Li M, et al. In vitro stent graft fenestration to preserve all supra-aortic branches in the treatment of a Stanford type A aortic arch dissection. Chin Med J (Engl), 2017, 130(15): 1878-1879.
9.	Roselli EE, Arko FR 3rd, Thompson MM, et al. Results of the Valiant Mona LSA early feasibility study for descending thoracic aneurysms. J Vasc Surg, 2015, 62(6): 1465-1471.
10.	Crawford SA, Osman E, Doyle MG, et al. Impact of fenestrated stent graft misalignment on patient outcomes. J Vasc Surg, 2019, 70(4): 1056-1064.

1. Bradshaw RJ, Ahanchi SS, Powell O, et al. Left subclavian artery revascularization in zone 2 thoracic endovascular aortic repair is associated with lower stroke risk across all aortic diseases. J Vasc Surg, 2017, 65(5): 1270-1279.
2. Waterford SD, Chou D, Bombien R, et al. Left subclavian arterial coverage and stroke during thoracic aortic endografting: a systematic review. Ann Thorac Surg, 2016, 101(1): 381-389.
3. Garg K, Maldonado TS. Further consideration for subclavian revascularization with TEVAR. Semin Vasc Surg, 2012, 25(4): 232-237.
4. Matsumura JS, Lee WA, Mitchell RS, et al. The Society for Vascular Surgery practice guidelines: management of the left subclavian artery with thoracic endovascular aortic repair. J Vasc Surg, 2009, 50(5): 1155-1158.
5. Zamor KC, Eskandari MK, Rodriguez HE, et al. Outcomes of thoracic endovascular aortic repair and subclavian revascularization techniques. J Am Coll Surg, 2015, 221(1): 93-100.
6. Ahmad W, Mylonas S, Majd P, et al. A current systematic evaluation and meta-analysis of chimney graft technology in aortic arch diseases. J Vasc Surg, 2017, 66(5): 1602-1610.
7. Bosiers MJ, Donas KP, Mangialardi N, et al. European multicenter registry for the performance of the chimney/snorkel technique in the treatment of aortic arch pathologic conditions. Ann Thorac Surg, 2016, 101(6): 2224-2230.
8. Wang T, Shu C, Li M, et al. In vitro stent graft fenestration to preserve all supra-aortic branches in the treatment of a Stanford type A aortic arch dissection. Chin Med J (Engl), 2017, 130(15): 1878-1879.
9. Roselli EE, Arko FR 3rd, Thompson MM, et al. Results of the Valiant Mona LSA early feasibility study for descending thoracic aneurysms. J Vasc Surg, 2015, 62(6): 1465-1471.
10. Crawford SA, Osman E, Doyle MG, et al. Impact of fenestrated stent graft misalignment on patient outcomes. J Vasc Surg, 2019, 70(4): 1056-1064.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

"J. D" technique: A method for in situ fenestration of left subclavian artery in thoracic endovascular aortic repair

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