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Comparison of total percutaneous in situ microneedle puncture and chimney technique for left subclavian artery fenestration in thoracic endovascular aortic repair for type B aortic dissection

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Abstract

Objective

To compare the outcomes of totally percutaneous in situ microneedle puncture for left subclavian artery (LSA) fenestration (ISMF) and chimney technique in type B aortic dissection (TBAD) during thoracic endovascular aortic repair (TEVAR).

Materials and methods

Data on patients who underwent either chimney–TEVAR (n = 89) or ISMF–TEVAR (n = 113) from October 2018 to April 2022 were analyzed retrospectively. The primary outcomes were mortality and major complications at 30 days and during follow-up.

Results

The technical success rate was 84.3% in the chimney group and 93.8% in the ISMF group (p = 0.027). The incidence of immediate endoleakage was significantly higher in the chimney than ISMF group (15.7% vs 6.2%, respectively; p = 0.027). The 1- and 3-year survival rates in the chimney and ISMF groups were 98.9% ± 1.1% vs 98.1% ± 0.9% and 86.5% ± 6.3% vs 92.6% ± 4.1%, respectively (log-rank p = 0.715). The 3-year rate of cumulative freedom from branch occlusion in the chimney and ISMF group was 95.4% ± 2.3% vs 100%, respectively (log-rank p = 0.023).

Conclusion

Both ISMF–TEVAR and chimney–TEVAR achieved satisfactory short- and mid-term outcomes for the preservation of the LSA in patients with TBAD. ISMF–TEVAR appears to offer better clinical outcomes with higher patency and lower reintervention rates. However, ISMF–TEVAR had longer operation times with higher procedure expenses.

Clinical relevance statement

When LSA revascularization is required during TEVAR, in situ, fenestration, and chimney techniques are all safe and effective methods; in situ, fenestration-TEVAR appears to offer better clinical outcomes, but takes longer and is more complicated.

Key Points

  • LSA revascularization during TEVAR reduces post-operative complication rates.

  • Both in situ ISMF–TEVAR and chimney–TEVAR are safe and effective techniques for the preservation of the LSA during TEVAR.

  • The chimney technique is associated with a higher incidence of endoleakage and branch occlusion, but ISMF–TEVAR is a more complicated and expensive technique.

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Abbreviations

ISMF:

In situ microneedle puncture of LSA for LSA fenestration

LSA:

Left subclavian artery

RTAD:

Retrograde type A aortic dissection

TBAD:

Type B aortic dissection

TEVAR:

Thoracic endovascular aortic repair

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China

    Peng Ye, Hongfei Miao, Qingle Zeng & Yong Chen

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  1. Peng Ye
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  2. Hongfei Miao
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  3. Qingle Zeng
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  4. Yong Chen
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Correspondence to Yong Chen.

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The scientific guarantor of this publication is Yong Chen.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all patients in this study.

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Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Our study subjects or cohorts have not been previously reported.

Methodology

  • Retrospective

  • Observational

  • Performed at one institution

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Ye, P., Miao, H., Zeng, Q. et al. Comparison of total percutaneous in situ microneedle puncture and chimney technique for left subclavian artery fenestration in thoracic endovascular aortic repair for type B aortic dissection. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10774-9

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  • DOI: https://doi.org/10.1007/s00330-024-10774-9

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