Presenter: Qingwei Ding

Affiliation: Shanghai General Hospital, China

Abstract

This article introduces a novel in-situ triple fenestration technique for aortic arch revascularization. In 14 cases (35.7% emergent), 100% technical success was achieved with 7.1% stroke rate, validating its efficacy in complex arch pathologies.

Introduction

Aortic arch involvement limits TEVAR applicability. This technique enhances fenestration accuracy via pre-placed sheaths and controlled shunting.

Case Study

A patient with twisted aortic arch and dissection:

Sheath Placement: 10F sheaths pre-inserted in supra-aortic branches.

Shunting: Femoral-carotid shunt maintained cerebral perfusion.

Fenestration: 18G needle fenestration followed by stent deployment.

Postoperative imaging confirmed branch patency without endoleak.

Conclusions

1.Pre-placed sheaths optimize fenestration precision.

2.Controlled shunting reduces cerebral ischemia.

3.The technique is adaptable to emergency scenarios.