https://orcid.org/0000-0003-1792-6101
An asymptomatic 70-year-old man was referred for an eccentric saccular aneurysm and <1.5 cm of healthy proximal descending thoracic aorta (Panels A and B). To ensure a satisfactory endovascular repair, a stent-graft (Percutek Therapeutics Inc., Beijing, China) (Panel D) was deployed distal to the left common carotid artery, covering the left subclavian artery (LSA). In situ fenestration was successfully performed using only the back end of a 0.035 inch guidewire (Terumo, Tokyo, Japan) (Panel C) to pierce the covered membrane. After balloon dilation, a silver flow cover stent (Life Tech, Shenzhen, China) was placed to restore the LSA. Completion angiogram demonstrated that the aneurysm was fully repaired, and the bridging stent was patent (Panel E). The 3-month follow-up computed tomographic angiography revealed complete aneurysm sac thrombus formation and patent LSA (Panels F and G). For patients with unfavourable proximal landing zones that require the intentional covering of LSA to extend the landing zone, different techniques and devices have been developed for revascularizing LSA, including a carotid-subclavian bypass, chimney techniques, and single-branched stent grafts.
The PERCUTEK Tianyi® stent-graft employs a special weaving technique that reduces membrane penetration force while maintaining structural integrity to prevent leakage (Panels D and H). Ex vivo measurements have indicated that special membranes require substantially smaller forces to be fenestrated than ordinary ones (Panel I). Furthermore, polyester fibres in specially woven membranes preserve better integrity (Panel J). This was the first in situ fenestration case of this stent-graft. Long-term results are awaited.
Acknowledgements
The authors thank Zheyun Li for preparing this manuscript.
Consent: The authors confirm that written consent for submission and publication of this case report including images and associated text has been obtained from the patient in line with COPE guidance.
Funding: This work is partially supported by the National Natural Science Foundation of China (grant number 82270415).
Data availability
The data underlying this article will be shared on reasonable request to the corresponding author.
Author notes
The work was performed at Zhongshan Hospital affiliated to Fudan University.
Conflict of interest: None declared.
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