Editor's Choice - Three Dimensional Printing Assisted Multi-fenestrated Endovascular Repair of the Aortic Arch: A Multicentre Study.

Abstract

This study aimed to evaluate the peri-operative and follow up results of multicentre 3D printing assisted fenestrated thoracic endovascular repair for aortic arch diseases in zones 0 and 1. A multicentre retrospective study of patients undergoing 3D printing assisted multi-fenestrated endovascular arch repair was conducted. The primary endpoints included death, complications, and technical success. Statistical analysis was performed using SPSS version 26, and Kaplan-Meier survival analysis was employed to calculate mid to long term outcomes. The study included 149 patients (mean age 62 ± 13 years; 87.9% men). Diagnoses included thoracic aortic dissection (50.3%, n = 75), aortic aneurysm (46.3%, n = 69), and penetrating aortic ulcer (3.4%, n = 5). The technical success rate was 94.0% (n = 140). Two patients died during the operation. The thirty day post-operative mortality rate was 2.7% (n = 4), while the incidence of cerebral infarction was 8.8% (n = 13), and spinal ischaemia occurred in 2.7% (n = 4). The median follow up was 28 months, during which nine died, two of which were aortic related. The overall endoleak rate was 7.0% (n = 10), comprising four type Ia, four type Ic, and two type IIIa endoleaks; nine underwent re-intervention. The one, two, and three year survival rates were 93.5% (standard error [SE] 2.1%), 90.0% (SE 2.7%), and 87.5% (SE 3.1%), respectively. For patients with complex aortic arch disease unfit for open surgery, 3D printing assisted fenestrated thoracic endovascular repair in zones 0 or 1 demonstrated a technically feasible solution with high success and acceptable 30 day mortality and complication rates. Broader validation with larger cohorts and extended follow up is required to establish the durability and safety of this technique as a viable alternative for aortic arch repair.