In situ Laser Fenestration of Visceral Endografts (InLoVE): Midterm Outcomes from a Multicentre Study.

Abstract

Emergency complex abdominal aortic diseases are challenging to treat. During in situ laser fenestration (ISLF), aortic branches are covered and flow is restored by in situ fenestration of the stent graft, with promising midterm results. This study aimed to expand on the limited body of knowledge of midterm outcomes of ISLF in renovisceral aortic pathology in a multicentre setting. Retrospective pooled data on consecutive ISLF cases of visceral aortic stent grafts undertaken between 2018 - 2023 in three aortic centres were analysed. Technical success was defined as successful vascularisation with a bridging stent graft and acceptable final angiographic images without signs of endoleak related to the bridging stent graft. Target vessel instability was defined as an endoleak related to the bridging stent graft, disconnection, kink, stenosis, occlusion of bridging stent, re-intervention to the bridging stent graft, or rupture or death related to the bridging stent graft. Sixtyfive ISLFs were performed in 34 patients, with a mean age 74 years. The procedure was acute in 79%, and 35% were ruptures. Pre-stenting was performed on 56 target vessels (86%). Four patients (12%) died within 30 days; all presented with a rupture. Technical success was achieved in 61 of 65 (94%) ISLFs. All failed cannulations were in the renal arteries: three due to difficult angulations and one dissected during cannulation. Median follow up was 16 (interquartile range 5, 22) months. Cumulative survival at six months, one, and two years was 88%, 81%, and 72%, respectively. Six (10%) target vessel instabilities were detected: two (3%) type III endoleaks and four (7%) stent stenosis; all of which required re-lining. Freedom from target vessel instability at six months until the end of follow up was 89%. On the latest follow up scan, all successfully deployed ISLF bridging stents were patent (primary assisted patency 100%; 61 of 61) without signs of type III endoleak. ISLF is a promising tool for emergency endovascular procedures in complex anatomies.