Abstract：Objective To explore the method and effect of reconstruction of left subclavian artery(LSA) in the thoracic endovascular aortic repair(TEVAR) with extracorporeal fenestration.Methods The clinical data of 67 patients with reconstruction of the LSA during the TEVAR by “fenestration in vitro” in the Department of Vascular Surgery of Nanjing Drum Tower Hospital and Xuzhou Central Hospital from January 2016 to December 2018 were retrospectively analyzed. The “fenestration in vitro” technique was used in 67 patients, including 51 males and 16 females, aged 41-76(63±5) years old. The cases were as follows: 50 cases of type B aortic dissection, 11 cases of thoracic aortic aneurysm, 4 cases of intramural hematoma, and 2 cases of aortic ulcer. The mortality, incidence of internal leakage, integrity, and patency of main and branch stents were observed.Results The technique was successful in 66 of the 67 patients. One patient was converted to the chimney technique. All 67 patients were followed up for 3-48 months. Immediately after operation, three cases showed a small amount of type Ⅰ internal leakage, which was not treated. CT angiography (CTA) results showed that the leakage disappeared 3 months after the operation. Two patients felt weakness of the left upper limb; one patient experienced dizziness. They recovered gradually during the follow-up period without limb ischemia and necrosis. All the stent branches were unobstructed. No complications, such as stent displacement and internal leakage, were found. No operation-related death occurred.Conclusions The technique of extracorporeal fenestration provides technical support for the reconstruction of LSA during the TEVAR. The method is simple and effective, and the short- and medium-term follow-up results are satisfactory.
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2021, Vol. 26 
