Antegrade in situ laser fenestration of aortic stent graft during endovascular aortic repair: A case report

Table 1 Summary of published antegrade in situ fenestration animal and benchtop studies

Ref.	Year	Model	Fenestration device	Guidance/landmarks of visceral arteries	Stent graft	Technical success rate1	Experimental results
Tse et al[6]	2007	Canine	Needle	(1) Intravascular ultrasound; and (2) Preliminary stenting of all visceral arteries	Endurant	(1) 0/2; and (2) 2/2	(1) The experiment was terminated; and (2) At the 1-mo follow-up, both renal arteries were patent. Stent fractures were observed bilaterally
Riga et al[7]	2009	Porcine	Needle	On a fixed fluoroscopic projection, the position of these target vessels was marked on the fluoroscopy screen	Valiant	2/2	There were no immediate complications. Both renal arteries were patent
Tse et al[8]	2010	Canine	Radiofrequency	Target vessels were marked with detachable coils or with hydrophilic catheters	Zenith	2/3	Thrombosis was seen in one stent during 1 mo of follow-up, while the other fenestrated artery remained patent
Saari et al[9]	2012	Porcine	Needle	Target vessels were marked with balloon catheters	Endurant, Talent	2/6	In one pig, the kidney showed clear signs of ischemic injury when autopsied
Ruthrauff et al[10]	2015	Benchtop	Radiofrequency	NA	Zenith, Endurant	8/8	NA
Piazza et al[11]	2017	Benchtop	Laser	A guiding catheter with EM sensor	NA	NA	NA
Condino et al[12]	2020	Benchtop	Laser	Simultaneous EM-guided navigation of guidewires and catheters	Zenith	22/22	NA

¹Number of successful fenestrations/number of target vessels.

NA: Not applicable; EM: Electromagnetic.

Table 2 Summary of published antegrade in situ fenestration clinical studies

Ref.	Year	No. of patients	Puncture method	Guidance/landmarks	Stent graft	Technical success rate1	Clinical outcomes
Bismuth et al[13]	2012	1	Needle	NA	C3 Excluder	1/1	At the 1-mo follow-up, the patient remained without complications. There was no evidence of endoleakage, migration or stent occlusion, and the bilateral renal arteries remained patent
Kölbel et al[19]	2013	1	Needle	Angiography and the marker at the proximal graft edge	Zenith	1/1	On CTA 4 d postoperatively, all side branches were fully preserved. Renal function was completely restored
Le Houérou et al[14]	2018	16	Laser	Preliminary stenting of all visceral arteries	Valiant, Endurant, Zenith	33/35	During a mean follow up of 17 mo, no deaths occurred. Four secondary procedures were required: Two related to fenestrations; one for stent dislocation; and one for stent stenosis. The follow up CTA demonstrated 97% primary patency
Leger et al[15]	2019	20	Laser	Image fusion guidance	Endurant	48/50	The 30-d safety rate was 90% (n = 2 deaths). At the one-week follow-up, all target vessels were patents, and two patients (15%) required a secondary procedure for endoleakage
Zhang et al[16]	2020	1	Laser	Preliminary stenting of all visceral arteries	Valiant	4/4	The 3-mo CTA demonstrated a decreased aneurysm sac, patent stent branches, and no endoleakage
Salib et al[17]	2021	1	Laser	Image fusion guidance	Endurant	3/3	The postoperative course was uneventful. The 6-mo CTA demonstrated an excluded aneurysm, patent stent branches, and no endoleakage

¹Number of successful fenestrations/number of target vessels.

NA: Not applicable; CTA: Computed tomography angiography.