Experience with the Ankura Thoracic Stent Graft and In-situ Fenestration for the Left Subclavian Artery with the Fu-Through Needle - a Technical Overview and Comparison to Similar Endovascular Techniques

Abstract

Thoracic endovascular aortic repair (TEVAR) is a widespread minimally invasive procedure prevalently used to treat thoracic aortic pathologies. However, when the left subclavian artery (LSA) is involved in the pathology, a more complex surgical approach is required to guarantee the perfusion of the vertebral and brachial arteries. In fact, coverage of the LSA has been proven to be associated with a higher risk of stroke, spinal cord ischemia, and arm ischemia.

Historically, carotid-subclavian bypass or subclavian transposition has been the only treatment options to restore the perfusion of the LSA. For the past 10 years, different endovascular techniques have been implemented in the endovascular armamentarium to reduce the risk of complications related to surgical treatment such as infection, bleeding, and chylothorax.

Currently, physician-modified grafts, in situ fenestration, chimneys, and branched or fenestrated devices are available. The aim of this overview is to describe the technique with the Ankura thoracic stent graft and in situ fenestration with the Futhrough needle and thus to shed light on the different approaches by comparing their pros and cons.

Zusammenfassung

Die thorakale endovaskuläre Aortenreparatur (TEVAR) ist ein weit verbreitetes minimalinvasives Verfahren, das häufig zur Behandlung von Pathologien der thorakalen Aorta eingesetzt wird. Wenn die linke Schlüsselbeinarterie in die Pathologie involviert ist, ist jedoch ein komplexerer chirurgischer Ansatz erforderlich, um die Perfusion der Hals- und Armarterien zu gewährleisten. Es wurde festgestellt, dass die Abdeckung der linken Schlüsselbeinarterie mit einem höheren Risiko für Schlaganfälle, Rückenmarksischämien und Armischämien verbunden ist.

Historisch gesehen waren die Karotis-Subclavia-Bypass- oder Subclavia-Transpositionsverfahren die einzigen Behandlungsoptionen zur Wiederherstellung der Perfusion der linken Schlüsselbeinarterie. In den letzten 10 Jahren wurden jedoch verschiedene endovaskuläre Techniken in das endovaskuläre Arsenal aufgenommen, um das Risiko von Komplikationen im Zusammenhang mit chirurgischer Behandlung wie Infektionen, Blutungen und Chylothorax zu reduzieren.

Derzeit stehen modifizierte Grafts, In-situ-Fenestration, „Chimneys“ und gebranchte oder fenestrierte Prothesen zur Verfügung. Das Ziel dieses Überblicks ist es, die Technik mit dem Ankura Thorax-Stentgraft und der In-situ-Fenestration mit dem Futhrough Needle zu beschreiben und somit die verschiedenen Ansätze zu beleuchten, indem ihre Vor- und Nachteile verglichen werden.

Schlüsselwörter

Aortenaneurysma - A. thoracalis - Aortenchirurgie - Aortenstentprothese - Endoleak - Endograft

Keywords

aortic aneurysm - aortic surgery - aortic stent prosthesis - endoprosthesis - endovascular treatment

Publication History

Received: 09 May 2023

Accepted after revision: 04 September 2023

Article published online:
16 October 2023

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