Three-branched in situ laser fenestration for the endovascular repair of total aortic arch disease: A retrospective analysis of 5-year outcomes

IF 3.6 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery Pub Date : 2026-05-01 Epub Date: 2025-12-19 DOI:10.1016/j.jvs.2025.11.042

Sen Yang PhD, MD , Xing Zhang PhD, MD , Xiaoyu Wu PhD, MD , Kaichuang Ye PhD, MD , Weimin Li PhD, MD , Jinbao Qin PhD, MD , Xinwu Lu PhD, MD

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引用次数: 0

Abstract

Objective

To evaluate the 5-year long-term outcomes of in situ laser fenestration (ISLF)-assisted thoracic endovascular aortic repair (TEVAR) for acute type A dissection involving zone 0 with all three supra-aortic branches reconstructed.

Methods

This single-center, retrospective consecutive series (2014-2021) included 152 zone 0 acute type A dissection patients treated with three-branched ISLF-assisted TEVAR. In the same timeframe, 286 contemporaneous patients at our institution were treated mainly with open or hybrid repair (not analyzed here). The primary end point was immediate technical success. Secondary end points included branch-stent patency at 1, 2, and 5 years and complete false-lumen thrombosis in the stent-covered segment at 1, 2, and 5 years, as well as postoperative complications.

Results

ISLF-assisted TEVAR with triple-branch reconstruction was performed in all 152 patients; immediate technical success was 95.4%. Within 30 days, 6 deaths (3.9%), 11 strokes (7.2%), 5 cases of spinal cord ischemia (3.3%), and 4 proximal stent-induced dissections (2.6%) were observed; no distal stent-induced dissections occurred. Long-term follow-up was available in 94.7% of patients (144/152). At a mean of 60 months (range, 12-72 months), branch-stent patency was 96.1% at 1 year, 95.0% at 2 years, and 94.7% at 5 years. Complete false-lumen thrombosis in the covered segment was 89.6%, 84.7%, and 82.6% at 1, 2, and 5 years, respectively. Over 5 years, all-cause mortality was 7.9% (n = 12) and reintervention 12.5% (n = 18).

Conclusions

In this single-center cohort, ISLF-assisted TEVAR for zone 0 acute type A dissection achieved high immediate technical success and acceptable complication rates with sustained branch patency over 5 years. These findings support the feasibility and safety of a standardized cerebral protection and device strategy, while prospective multicenter controlled studies are needed to confirm generalizability and comparative effectiveness.

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三支原位激光开窗治疗全主动脉弓病变血管内修复：5年回顾性分析

目的：评价原位激光开窗（ISLF）辅助胸椎血管内主动脉修复术（TEVAR）治疗急性A型夹层累及0区并重建主动脉上三条分支的5年远期疗效。方法：该单中心、回顾性连续研究（2014-2021）纳入了152例使用三支islf辅助TEVAR治疗的0区急性A型夹层患者。同一时间段内，我院同期286例患者主要采用开放式或混合式修复（本文未作分析）。主要终点是立即取得技术上的成功。次要终点包括1年、2年和5年支路支架通畅，1年、2年和5年支架覆盖段完全假腔血栓形成，以及术后并发症。结果：152例患者均行islf辅助TEVAR合并三支重建；直接的技术成功是95.4%。在30天内，观察到死亡3.9% (n=6)，中风7.2% (n=11)，脊髓缺血3.3% (n=5)，近端支架性夹层2.6% (n=4)；未发生远端支架引起的剥离。长期随访率为94.7%（144/152）。平均60个月（范围12-72），1年支支架通畅度为96.1%，2年为95.0%，5年为94.7%。在1年、2年和5年时，覆盖段的完全假腔血栓形成率分别为89.6%、84.7%和82.6%。5年内，全因死亡率为7.9% (n=12)，再干预率为12.5% （n=18）。结论：在这个单中心队列中，islf辅助TEVAR治疗0区急性A型夹层获得了很高的直接技术成功率和可接受的并发症发生率，且分支持续通畅超过5年。这些发现支持标准化脑保护和装置策略的可行性和安全性，但需要前瞻性的多中心对照研究来确认普遍性和比较有效性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Vascular Surgery 医学-外科

CiteScore

7.70

自引率

18.60%

发文量

1469

审稿时长

54 days

期刊介绍： Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.