Location
Suwanee, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Introduction: Endovascular laser fenestration (LFEN) has emerged as a popular method for thoracoabdominal aneurysm (TAA) repair, but prolonged branch vessel ischemia during graft deployment remains a concern. We compared a conventional proximal-to-distal “top-down” fenestration strategy with a "superior mesenteric artery first” (SMA) approach designed to prioritize visceral perfusion and minimize bowel ischemia.
Methods: We performed a single-center, single-operator retrospective review of two patients undergoing LFEN repair for complex aortic aneurysms using either a “top-down” or “SMA-first” approach. Outcomes included ischemia time, postoperative clinical and laboratory evidence of visceral/renal malperfusion, and procedural metrics such as time to fabric penetration and stent placement.
Results: Two patients' outcomes were retrospectively reviewed after receiving endovascular LFEN repair of a type II TAA (patient A) and type IV TAA (patient B). Patient A received a “top down” approach, while Patient B received a “SMA-first” approach. Patient A had an initial fabric penetration at 5 minutes, and initial SMA fabric fenestration at 28 minutes. In Patient B, since the SMA was the first vessel to be fenestrated, both initial fabric penetration and SMA revascularization time was 6 minutes. Both patients had complete revascularization in under 58 minutes.
Discussion: Conventionally, a “top down” approach was used to target vessel stents that are performed in a sequential anatomic fashion (Celiac, SMA, Renal). This reduces the chances of damaging the previously placed stent. The drawback is a presumably longer time to SMA revascularization. Although the “top-down” approach delayed SMA revascularization by nearly 20 minutes compared to the “SMA-first” strategy, there was no difference in 30-day morbidity, mortality, or evidence of visceral/renal malperfusion. Serum liver function studies, and creatinine levels all remained within normal limits, or comparable to baseline. Both patients denied any postoperative abdominal pain, or exhibited any abdominal tenderness. This study provides proof of concept and can be expanded with additional patients.
Embargo Period
6-1-2026
Included in
Sequence of Target Vessel Revascularization Does Not Affect Outcomes During Endovascular In-Situ Laser Fenestrated Repair of Complex Aortic Aneurysms
Suwanee, GA
Introduction: Endovascular laser fenestration (LFEN) has emerged as a popular method for thoracoabdominal aneurysm (TAA) repair, but prolonged branch vessel ischemia during graft deployment remains a concern. We compared a conventional proximal-to-distal “top-down” fenestration strategy with a "superior mesenteric artery first” (SMA) approach designed to prioritize visceral perfusion and minimize bowel ischemia.
Methods: We performed a single-center, single-operator retrospective review of two patients undergoing LFEN repair for complex aortic aneurysms using either a “top-down” or “SMA-first” approach. Outcomes included ischemia time, postoperative clinical and laboratory evidence of visceral/renal malperfusion, and procedural metrics such as time to fabric penetration and stent placement.
Results: Two patients' outcomes were retrospectively reviewed after receiving endovascular LFEN repair of a type II TAA (patient A) and type IV TAA (patient B). Patient A received a “top down” approach, while Patient B received a “SMA-first” approach. Patient A had an initial fabric penetration at 5 minutes, and initial SMA fabric fenestration at 28 minutes. In Patient B, since the SMA was the first vessel to be fenestrated, both initial fabric penetration and SMA revascularization time was 6 minutes. Both patients had complete revascularization in under 58 minutes.
Discussion: Conventionally, a “top down” approach was used to target vessel stents that are performed in a sequential anatomic fashion (Celiac, SMA, Renal). This reduces the chances of damaging the previously placed stent. The drawback is a presumably longer time to SMA revascularization. Although the “top-down” approach delayed SMA revascularization by nearly 20 minutes compared to the “SMA-first” strategy, there was no difference in 30-day morbidity, mortality, or evidence of visceral/renal malperfusion. Serum liver function studies, and creatinine levels all remained within normal limits, or comparable to baseline. Both patients denied any postoperative abdominal pain, or exhibited any abdominal tenderness. This study provides proof of concept and can be expanded with additional patients.