{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T04:34:05Z","timestamp":1791866045830,"version":"4.3.4"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T00:00:00Z","timestamp":1685491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>To investigate the safety and efficacy of homemade fenestration and chimney techniques for the left subclavian artery (LSA) revascularization during zone 2 thoracic endovascular aortic repair (TEVAR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From February 2017 to February 2021, 41 patients undergoing fenestration technique (group A) and 42 patients undergoing chimney technique (group B) to preserve the LSA during zone 2 TEVAR were enrolled in the present study. The procedure was indicated for dissections with unsuitable proximal landing zone with refractory pain and hypertension, rupture and malperfusion, and high-risk radiographic features. The baseline characteristics, peri-procedure, and follow-up clinical and radiographic data were recorded and analyzed. The primary endpoint was clinical success, and the secondary endpoints were rupture-free survival, LSA patency, and complications. Aortic remodeling, defined as patency, partial and complete thrombosis of the false lumen, was also analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Technical success was achieved in 38 and 41 patients in groups A and B, respectively. Four intervention-related deaths were confirmed, two in each group. Immediate post-procedural endoleaks were detected in two and three patients in group A and B, respectively. No other major complications were found in either group, except for one retrograde type A dissection in group A. During follow-up, the initial clinical success rates were 90.24% and 92.86% in groups A and B, respectively. The primary and secondary mid-term clinical success rates were 87.5% and 90% in group A, and both of them were 92.68% in group B. Rupture-free survival and LSA patency were not significantly different between the two groups. The incidence of complete thrombosis in the aorta distal to the stent graft was 67.65% and 61.11% in groups A and B, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Apart from the lower clinical success rate of fenestration technique, both physician-modified techniques are available for LSA revascularization during zone 2 TEVAR and significantly promote favorable aortic remodeling.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2023.1144751","type":"journal-article","created":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T05:31:20Z","timestamp":1685511080000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Homemade fenestration and chimney techniques for the left subclavian artery revascularization during zone 2 thoracic endovascular aortic repair"],"prefix":"10.3389","volume":"10","author":[{"given":"Jiacheng","family":"Ye","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuliang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongzheng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiyang","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,5,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1093\/ejcts\/ezaa268","article-title":"Current options and recommendations for the use of thoracic endovascular aortic repair in acute and chronic thoracic aortic disease: an expert consensus document of the European society for cardiology (ESC) working group of cardiovascular surgery, the ESC working group on aorta and peripheral vascular diseases, the European association of percutaneous cardiovascular interventions (EAPCI) of the ESC and the European association for cardio-thoracic surgery (EACTS)","volume":"59","author":"Czerny","year":"2021","journal-title":"Eur J Cardiothorac Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.ejvs.2016.06.005","article-title":"Editor's choice \u2013 management of descending thoracic aorta diseases","volume":"53","author":"Riambau","year":"2017","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1016\/j.athoracsur.2015.08.069","article-title":"The effect of left subclavian artery coverage in thoracic endovascular aortic repair","volume":"101","author":"Sobocinski","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1330","DOI":"10.1016\/j.jvs.2019.03.022","article-title":"Meta-analysis of the outcomes of revascularization after intentional coverage of the left subclavian artery for thoracic endovascular aortic repair","volume":"70","author":"Chen","year":"2019","journal-title":"J Vasc Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1016\/j.jvs.2022.02.031","article-title":"A systematic review and meta-analysis of stroke rates in patients undergoing thoracic endovascular aortic repair for descending thoracic aortic aneurysm and type B dissection","volume":"76","author":"Karaolanis","year":"2022","journal-title":"J Vasc Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1177\/1526602819890107","article-title":"Off-the-shelf devices for treatment of thoracic aortic diseases: midterm follow-up of TEVAR with chimneys or physician-made fenestrations","volume":"27","author":"Zhang","year":"2020","journal-title":"J Endovasc Ther"},{"key":"B7","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1093\/ejcts\/ezu266","article-title":"The chimney technique for preserving the left subclavian artery in thoracic endovascular aortic repair","volume":"47","author":"Xue","year":"2015","journal-title":"Eur J Cardiothorac Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/j.ejvs.2017.11.012","article-title":"Fenestrated thoracic endovascular aortic repair using physician modified stent grafts for acute type B aortic dissection with unfavourable landing zone","volume":"55","author":"Zhu","year":"2018","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.1016\/j.athoracsur.2016.03.091","article-title":"Branched endovascular therapy of the distal aortic arch: preliminary results of the feasibility multicenter trial of the gore thoracic branch endoprosthesis","volume":"102","author":"Patel","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"406","DOI":"10.21037\/acs.2018.03.13","article-title":"Status of branched endovascular aortic arch repair","volume":"7","author":"van Bakel","year":"2018","journal-title":"Ann Cardiothorac Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1524","DOI":"10.1016\/j.jvs.2020.01.072","article-title":"Early and midterm outcomes of in situ laser fenestration during thoracic endovascular aortic repair for acute and subacute aortic arch diseases and analysis of its complications","volume":"72","author":"Li","year":"2020","journal-title":"J Vasc Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.21037\/jtd.2019.04.15","article-title":"Long-term outcomes of balloon-expandable bare stent as chimney stent in thoracic endovascular aortic repair for supra-aortic branches reconstruction","volume":"11","author":"Liu","year":"2019","journal-title":"J Thorac Dis"},{"key":"B13","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1177\/1526602816673326","article-title":"Analysis of risk factors for early type I endoleaks after thoracic endovascular aneurysm repair","volume":"24","author":"Kanaoka","year":"2017","journal-title":"J Endovasc Ther"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2S","DOI":"10.1016\/j.jvs.2014.12.009","article-title":"Society for vascular surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication","volume":"61","author":"Conte","year":"2015","journal-title":"J Vasc Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1022","DOI":"10.1016\/j.jvs.2010.07.008","article-title":"Reporting standards for thoracic endovascular aortic repair (TEVAR)","volume":"52","author":"Fillinger","year":"2010","journal-title":"J Vasc Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/j.athoracsur.2021.02.092","article-title":"Endovascular repair for acute type B aortic dissection with unfavorable proximal landing zone","volume":"113","author":"Chang","year":"2022","journal-title":"Ann Thorac Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"466.e3","DOI":"10.1016\/j.jvs.2020.05.063","article-title":"Periscope sandwich stenting as an alternative to open cervical revascularization of left subclavian artery during zone 2 thoracic endovascular aortic repair","volume":"73","author":"Johnson","year":"2021","journal-title":"J Vasc Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.avsg.2019.02.017","article-title":"Thoracic endovascular aortic repair on zone 2 landing for type B aortic dissection","volume":"60","author":"Miura","year":"2019","journal-title":"Ann Vasc Surg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.1016\/j.jvs.2016.10.111","article-title":"Left subclavian artery revascularization in zone 2 thoracic endovascular aortic repair is associated with lower stroke risk across all aortic diseases","volume":"65","author":"Bradshaw","year":"2017","journal-title":"J Vasc Surg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1016\/j.ejvs.2020.08.022","article-title":"Endovascular repair of aortic dissection involving the left subclavian artery by castor stent graft: a multicentre prospective trial","volume":"60","author":"Jing","year":"2020","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1177\/1526602819881128","article-title":"Midterm follow-up of fenestrated and scalloped physician-modified endovascular grafts for zone 2 TEVAR","volume":"27","author":"Chassin-Trubert","year":"2020","journal-title":"J Endovasc Ther"},{"key":"B22","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.ejvs.2017.06.014","article-title":"Mid-term results of chimney and periscope grafts in supra-aortic branches in high risk patients","volume":"54","author":"Pecoraro","year":"2017","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1016\/j.jvir.2020.02.025","article-title":"In situ laser stent graft fenestration of the left subclavian artery during thoracic endovascular repair of type B aortic dissection with limited proximal landing zones: 5-year outcomes","volume":"31","author":"Zhao","year":"2020","journal-title":"J Vasc Interv Radiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1664","DOI":"10.1016\/j.jvs.2018.09.052","article-title":"Midterm results of laser generated in situ fenestration of the left subclavian artery during thoracic endovascular aneurysm repair","volume":"69","author":"Sonesson","year":"2019","journal-title":"J Vasc Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"629.e1","DOI":"10.1016\/j.jtcvs.2019.07.096","article-title":"Handmade fenestrated stent grafts to preserve all supra-aortic branches in thoracic endovascular aortic repair","volume":"160","author":"Kuo","year":"2020","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1177\/1708538118812548","article-title":"Chimney parallel grafts\u00a0and\u00a0thoracic endovascular aortic repair for blunt traumatic thoracic aortic injuries: a systematic review","volume":"27","author":"Carter","year":"2018","journal-title":"Vascular"},{"key":"B27","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1016\/j.jvs.2019.05.049","article-title":"Chimney stent graft for left subclavian artery preservation during thoracic endograft placement","volume":"71","author":"Ramdon","year":"2020","journal-title":"J Vasc Surg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1177\/1526602815590579","article-title":"Perioperative and long-term outcomes of endovascular treatment for subclavian artery disease from a large multicenter registry","volume":"22","author":"Soga","year":"2015","journal-title":"J Endovasc Ther"},{"key":"B29","doi-asserted-by":"publisher","first-page":"9.e3","DOI":"10.1016\/j.jvs.2016.11.063","article-title":"Outcomes of thoracic endovascular aortic repair using aortic arch chimney stents in high-risk patients","volume":"66","author":"Voskresensky","year":"2017","journal-title":"J Vasc Surg"},{"key":"B30","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1016\/j.jvs.2018.07.022","article-title":"Outcomes of carotid-subclavian bypass performed in the setting of thoracic endovascular aortic repair","volume":"69","author":"Voigt","year":"2019","journal-title":"J Vasc Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.1016\/j.jtcvs.2019.03.060","article-title":"Concomitant left subclavian artery revascularization with carotid-subclavian transposition during zone 2 thoracic endovascular aortic repair","volume":"159","author":"Bianco","year":"2020","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1437","DOI":"10.21037\/jtd.2020.03.10","article-title":"Endovascular treatment for aortic arch pathologies: chimney, on-the-table fenestration, and in-situ fenestration techniques","volume":"12","author":"Shu","year":"2020","journal-title":"J Thorac Dis"},{"key":"B33","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1093\/ejcts\/ezy313","article-title":"Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European association for cardio-thoracic surgery (EACTS) and the European society for vascular surgery (ESVS)","volume":"55","author":"Czerny","year":"2019","journal-title":"Eur J Cardiothorac Surg"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1144751\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T05:31:27Z","timestamp":1685511087000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1144751\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,31]]},"references-count":33,"alternative-id":["10.3389\/fcvm.2023.1144751"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2023.1144751","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,31]]},"article-number":"1144751"}}