Antegrade Laser In Situ Fenestration For the Treatment of Thoracoabdominal and Juxtarenal Aortic Aneurysms

This case series aims to evaluate the feasibility and safety of in situ antegrade laser fenestration as an alternative treatment for urgent and emergent repair of thoracoabdominal and juxtarenal aortic aneurysms. Patients with high-risk thoracoabdominal or juxtarenal aneurysms who were not suitable candidates for open repair or custom-made devices were selected for this study. Bare-metal balloon expandable stents were pre-placed in each target vessel followed by the deployment of a thoracic or bifurcated abdominal endograft across the visceral segment. Using a steerable sheath and laser catheter, the stent graft fabric was crossed to position the fenestration. Following sequential balloon dilation, a covered bridging stent was deployed and flared. Results are presented as mean ± standard deviation. Four patients were treated between November 2022 and February 2023. Three patients underwent a four-vessel laser fenestration for symptomatic aneurysms, and one patient underwent a single renal laser fenestration electively, for a total of 13 fenestrations. The mean operative time was 266 ± 45 minutes. Technical success was achieved in all cases with no in-hospital mortality, 30-day mortality, or major morbidity. The mean time to visceral re-perfusion was 16 ± 8 minutes for the superior mesenteric artery, 46 ± 7 minutes for the left renal artery, 63 ± 39 minutes for the right renal artery, and 107 ± 21 minutes for the celiac artery. No reinterventions were required in the early follow-up period. Two patients had endoleaks, one with persistent retrograde filling of the false lumen and one with a type III endoleak from a renal fenestration. The early results suggest that in situ antegrade laser fenestration is a feasible and safe treatment option for urgent and emergent aneurysms involving the visceral segment in high-risk patients. However, more patients and longer-term follow-up is needed to determine the durability and safety of this procedure.