{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T10:02:06Z","timestamp":1777543326942,"version":"3.51.4"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T00:00:00Z","timestamp":1695945600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81870347, 82370498"],"award-info":[{"award-number":["81870347, 82370498"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Special instruments are needed for the revascularization of aortic branches in <jats:italic>in situ<\/jats:italic> fenestration during thoracic endovascular aortic repair (TEVAR). This prospective study compared the effectiveness and safety of three currently used fenestraters: laser, needle, and Quick Fenestrater (QF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In all, 101 patients who underwent TEVAR for aortic disease (dissection, <jats:italic>n<\/jats:italic>\u2009=\u200962; aneurysm, <jats:italic>n<\/jats:italic>\u2009=\u200916, or ulcer, <jats:italic>n<\/jats:italic>\u2009=\u200923) were enrolled. All patients were randomly assigned to three groups: 34 were assigned to laser fenestration, 36 to needle fenestration, and 31 to QF fenestration. The epidemiological data, treatment, imaging findings, and follow-up outcomes were analyzed using data from the medical records.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The technical success rates of the laser, needle, and QF fenestration groups were 94.1%, 94.4%, and 100% (<jats:italic>p<\/jats:italic>\u2009&amp;gt;\u20090.05). After correction of mixed factors such as age and gender, it was showed the average operative time (Laser group: 130.01\u2009\u00b1\u20099.36\u2005min\/ Needle group: 149.80\u2009\u00b1\u200910.18\u2005min vs. QF group: 101.10\u2009\u00b1\u20096.75\u2005min, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), fluoroscopy time (Laser group: 30.16\u2009\u00b1\u20099.81\u2005min\/ Needle group: 40.20\u2009\u00b1\u20099.91\u2005min vs. QF group: 19.91\u2009\u00b1\u20095.42\u2005min, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), fenestration time (Laser group 5.50\u2009\u00b1\u20093.10\u2005min \/ Needle group 3.50\u2009\u00b1\u20091.50\u2005min vs. QF group 0.67\u2009\u00b1\u20090.06\u2005min, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), and guide wire passage time after fenestration (Laser group 5.10\u2009\u00b1\u20091.70\u2005min \/ Needle group 4.28\u2009\u00b1\u20091.60\u2005min vs. QF group 0.07\u2009\u00b1\u20090.01\u2005min, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001) were all shorter with QF fenestration than with the other two tools. The overall perioperative complication rates of the laser, needle, and QF fenestration groups were 5.9%, 5.6%, and 0% (p\u2009&amp;gt;\u20090.05): One case of sheath thermal injury and one case of vertebral artery ischemia occurred in the laser fenestration group; one case each of access site hematoma and brachial artery thrombosis were reported in the needle fenestration group. 89 (88.1%, 89\/101) patients were followed for a median of 12.6\u2009\u00b1\u20091.6 months. The overall postoperative complication rates of the laser, needle, and QF fenestration groups were 3.3%, 6.5%, and 0% (p\u2009&amp;gt;\u20090.05): In the laser fenestration group, there was one death due to postoperative ST-segment elevation myocardial infarction; in the needle fenestration group, one patient developed occlusion of the bridge stent; no complications occurred in the QF group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>All three fenestration methods were effective in reconstructing supra-arch artery during TEVAR. QF fenestration required less contrast agent, with a shorter surgery duration and fewer complications than laser and needle fenestration.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2023.1250177","type":"journal-article","created":{"date-parts":[[2023,9,30]],"date-time":"2023-09-30T21:44:48Z","timestamp":1696110288000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparative effectiveness and safety of laser, needle, and \u201cquick fenestrater\u201d in in situ fenestration during thoracic endovascular aortic repair"],"prefix":"10.3389","volume":"10","author":[{"given":"Xiaokai","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianjin","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kangkang","family":"Zhi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sili","family":"Zou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Jin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Bai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lefeng","family":"Qu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,29]]},"reference":[{"key":"B1","first-page":"81","article-title":"Advanced 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