Endovascular Total Arch Repair Using In Situ Fenestration for Arch XXXX and Chronic Type A Dissection.

@entity1 @entity449 @entity1070 @entity439 @entity1129
BACKGROUND: Total arch replacement and ascending aorta and arch replacement are the gold standard treatments for @entity449 and are possible treatment strategies for chronic @entity1129 dissection, with good reported outcomes. However, because total arch replacement is extremely invasive, it can be difficult to perform in some @entity1 . We designed an endovascular total arch repair procedure with the use of in situ fenestration and commercially available devices, and we present our initial experience. METHODS: Seven @entity1 (chronic @entity1129 aortic dissection, n  = 3; thoracic arch @entity439 , n  = 4) who underwent endovascular total arch repair with the use of in situ fenestration thoracic endovascular aortic repair from a zone 0 landing were retrospectively analyzed. All the procedures were performed under general anesthesia and cardiopulmonary bypass. The triple branches were manually punctured in a retrograde manner with the use of an 18-gauge/30-cm needle or a 21-gauge aspiration needle, and all the branches were reconstructed with the use of stent grafts; balloon touch-up was performed if appropriate. RESULTS: The procedure was successful in 6 of the 7 @entity1 ; the remaining 1 @entity1 additionally underwent an axillary-axillary artery bypass during the operation because the left subclavian artery was difficult to puncture. All the @entity1 had an acceptable postoperative course, with no 30-day and in-hospital deaths. None of the @entity1 had @entity1070 , and all the @entity1 exhibited a reduction in @entity439 diameter or thrombosed false lumen during a mean follow-up period of 17.6 months. CONCLUSIONS: Endovascular total arch repair with the use of in situ fenestration can be performed with commercially available devices with acceptable interim results.
