{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T15:16:37Z","timestamp":1783350997134,"version":"3.54.6"},"reference-count":32,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Thoracic endovascular aortic repair (TEVAR) is an established minimally invasive approach for selected aortic arch pathologies; however, it is associated with risks including stroke and spinal cord ischemia. Revascularization techniques, such as in situ fenestration (ISF), play a critical role in preserving supra-aortic branch perfusion and reducing neurological complications. Methods: This prospective, single-center observational cohort study enrolled 74 consecutive patients undergoing TEVAR with ISF between October 2017 and September 2023. Data collected included demographics, lesion morphology, procedural details, and clinical outcomes. The primary endpoint was procedural technical success; secondary endpoints included 30-day complications, reintervention rate, and all-cause mortality. Results: Technical success was achieved in 100% of cases (74\/74; 95% CI: 95.2\u2013100.0%), defined as successful fenestration creation, patent bridging stent graft without kinking or embolization, absence of Type I or III endoleak on completion angiography, and restored antegrade branch flow. Physician-modified fenestration was combined with ISF-thoracic endovascular aortic repair (TEVAR) in 28.4% (21\/74) of cases. At 30-day follow-up, 30-day clinical success (freedom from mortality, reintervention, and procedure-related complications) was achieved in 87.8% (65\/74) of patients. No mortality was recorded at 30 days. Treatment-related complications included subclavian branch thrombosis (n = 1, 1.4%), transient ischemic attack (n = 1, 1.4%), and endoleaks (n = 7, 9.5%; including Type Ia, Type II, and Type III), with reintervention required in 6 patients (8.1%) during the follow-up period. Beyond 30 days, three late deaths were documented: one aorta-related death (aneurysm rupture at 9 months), one neurological death (ischemic stroke at 13 months), and one cardiovascular death (myocardial infarction at 60 days post-procedure), yielding a late all-cause mortality rate of 4.1% (3\/74). Conclusions: ISF-TEVAR demonstrated a high procedural technical success rate and a low 30-day complication and mortality profile in this single-center prospective series of selected patients treated at an experienced center. These early and mid-term results are encouraging; however, given the single-center, non-comparative design and limited standardized follow-up, broader conclusions regarding durability and comparative effectiveness remain premature. Larger multicenter prospective studies with standardized long-term imaging follow-up are warranted.<\/jats:p>","DOI":"10.3390\/jcm15135267","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T13:43:14Z","timestamp":1783345394000},"page":"5267","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Safety and Feasibility of In Situ Fenestration in the Aortic Arch: A Prospective Single-Center Observational Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Ralf","family":"Kolvenbach","sequence":"first","affiliation":[{"name":"Sana Hospital Group, Department of Vascular Surgery, 40625 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang","family":"Shu","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing 100037, China"},{"name":"National Center for Cardiovascular Diseases, Beijing 100037, China"},{"name":"Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa R.","family":"Lica","sequence":"additional","affiliation":[{"name":"Sana Hospital Group, Department of Vascular Surgery, 40625 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1055\/s-0035-1558824","article-title":"TEVAR: Endovascular Repair of the Thoracic Aorta","volume":"32","author":"Nation","year":"2015","journal-title":"Semin. Interv. Radiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1080\/0886022X.2021.1905664","article-title":"Outcomes and Risk Management in Type B Aortic Dissection Patients with Acute Kidney Injury: A Concise Review","volume":"43","author":"Chen","year":"2021","journal-title":"Ren. Fail."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1806","DOI":"10.1111\/jocs.15349","article-title":"Non-A Non-B Aortic Dissection: A Literature Review","volume":"36","author":"Howard","year":"2021","journal-title":"J. Card. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1055\/s-0038-1666972","article-title":"Indications for Thoracic EndoVascular Aortic Repair (TEVAR): A Brief Review","volume":"27","author":"Manetta","year":"2018","journal-title":"Int. J. Angiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1055\/s-0040-1714089","article-title":"Complications and Management of the Thoracic Endovascular Aortic Repair","volume":"8","author":"Chen","year":"2020","journal-title":"Aorta"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.ijsu.2020.08.051","article-title":"Comparison of the Efficacy and Safety of Thoracic Endovascular Aortic Repair with Open Surgical Repair and Optimal Medical Therapy for Acute Type B Aortic Dissection: A Systematic Review and Meta-Analysis","volume":"83","author":"Liu","year":"2020","journal-title":"Int. J. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/j.jacc.2018.10.086","article-title":"Endovascular vs. Open Repair of Intact Descending Thoracic Aortic Aneurysms","volume":"73","author":"Chiu","year":"2019","journal-title":"JACC"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.jtcvs.2022.02.007","article-title":"Neurological Event Rates and Associated Risk Factors in Acute Type B Aortic Dissections Treated by Thoracic Aortic Endovascular Repair","volume":"167","author":"Reutersberg","year":"2024","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.ejvs.2020.11.021","article-title":"Silent Brain Infarction After Endovascular Arch Procedures: Preliminary Results from the STEP Registry","volume":"61","author":"Charbonneau","year":"2021","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1016\/j.ejvs.2019.05.011","article-title":"Incidence and Predictors of Neurological Complications Following Thoracic Endovascular Aneurysm Repair in the Global Registry for Endovascular Aortic Treatment","volume":"58","author":"Piazza","year":"2019","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_11","first-page":"e107","article-title":"RS08. Rate of Stroke Following Endovascular Aortic Interventions in the Society for Vascular Surgery Vascular Quality Initiative","volume":"69","author":"Swerdlow","year":"2019","journal-title":"J. Vasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","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":"ref_13","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1177\/1708538120902650","article-title":"Methods and Clinical Outcomes of in Situ Fenestration for Aortic Arch Revascularization during Thoracic Endovascular Aortic Repair","volume":"28","author":"Li","year":"2020","journal-title":"Vascular"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1109\/RBME.2021.3085484","article-title":"A Systematic Review on Methods and Tools for the In Situ Fenestration of Aortic Stent-Graft","volume":"16","author":"Piazza","year":"2023","journal-title":"IEEE Rev. Biomed. Eng."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.avsg.2021.05.006","article-title":"Laser in Situ Fenestration in Thoracic Endovascular Aortic Repair: A Single-Center Analysis","volume":"76","author":"Evans","year":"2021","journal-title":"Ann. Vasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2094","DOI":"10.1177\/15266028241234497","article-title":"Early and Midterm Outcomes of Endovascular Aortic Arch Repair Using In Situ Laser Fenestration","volume":"26","author":"Nana","year":"2025","journal-title":"J. Endovasc. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Li, J., Xue, Y., Li, S., Sun, L., Wang, L., Wang, T., Fang, K., Luo, M., Li, X., and He, H. (2022). Outcomes of Thoracic Endovascular Aortic Repair with Chimney Technique for Aortic Arch Diseases. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.868457"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Li, X., Shu, C., Li, Q., He, H., Li, M., Wang, L., Li, J., Liu, D., and Du, M. (2021). Self-Radiopaque Markers Guiding Physician-Modified Fenestration (S-Fenestration) in Aortic Arch Endovascular Repair. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.713301"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Aljabri, B., Iqbal, K., Alanezi, T., Al-Salman, M., Altuwaijri, T., Aldossary, M.Y., Alarify, G.A., Alhadlaq, L.S., Alhamlan, S.A., and AlSheikh, S. (2024). Thoracic Endovascular Aortic Repair and Endovascular Aneurysm Repair Approaches for Managing Aortic Pathologies: A Retrospective Cohort Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13185450"},{"key":"ref_20","unstructured":"Lamed (2025, February 17). AnkuraTM TAA Stent Graft System. Available online: https:\/\/www.lamed.de\/en\/products\/ankura-tm-taa-stent-graft-system."},{"key":"ref_21","unstructured":"Gore Medical (2025, February 17). VIABAHN\u00ae Endoprosthesis. Available online: https:\/\/www.goremedical.com\/products\/viabahn."},{"key":"ref_22","unstructured":"BD (2025, February 17). FluencyTM Plus Endovascular Stent Graft. Available online: https:\/\/www.bd.com\/en-us\/products-and-solutions\/products\/product-families\/fluency-plus-endovascular-stent-graft."},{"key":"ref_23","unstructured":"Biotronik (2025, February 17). Dynamic\u00ae Balloon-Expandable Stent System. Available online: https:\/\/www.biotronik.com."},{"key":"ref_24","unstructured":"Medtronic (2025, February 17). ValiantTM Thoracic Stent Graft with CaptiviaTM Delivery System. Available online: https:\/\/www.medtronic.com\/en-us\/healthcare-professionals\/products\/cardiovascular\/aortic\/aortic-stent-grafts\/valiant-thoracic-stent-graft-with-captivia-delivery-system.html."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.avsg.2022.06.004","article-title":"TEVAR with Supra-Aortic Trunk Revascularization Is Associated with Increased Risk of Periprocedural Ischemic Stroke","volume":"87","author":"Li","year":"2022","journal-title":"Ann. Vasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"6088","DOI":"10.21037\/jtd.2018.10.99","article-title":"Risk of Spinal Cord Ischemia after Thoracic Endovascular Aortic Repair","volume":"10","author":"Xue","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","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":"ref_28","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.athoracsur.2019.02.026","article-title":"Physician-Modified Thoracic Stent Grafts for the Arch After Surgical Treatment of Type A Dissection","volume":"108","author":"Gandet","year":"2019","journal-title":"Ann. Thorac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Knapsis, A., Seker, M.M., Schelzig, H., and Wagenhauser, M.U. (2024). Comparative Evaluation of the Short-Term Outcome of Different Endovascular Aortic Arch Procedures. J. Clin. Med., 13.","DOI":"10.3390\/jcm13164594"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s13019-018-0825-3","article-title":"Neurological Complications after Thoracic Endovascular Aortic Repair. Does the Left Subclavian Artery Coverage without Revascularization Increase the Risk of Neurological Complications in Patients after Thoracic Endovascular Aortic Repair?","volume":"14","author":"Janczak","year":"2019","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e232","DOI":"10.1016\/j.ejvs.2019.06.813","article-title":"Comparison of In Situ Fenestration and Physician-Modified Fenestration for Left Subclavian Artery Revascularization During Thoracic Endovascular Aortic Repair","volume":"58","author":"Fang","year":"2019","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Li, G., Li, M., Dong, Z., Gu, J., Liu, H., Xu, X., Gu, W., Shao, Y., and Ni, B. (2024). In Situ Needle Fenestration for Aortic Arch Conditions during Thoracic Endovascular Aortic Repair. BMC Cardiovasc. Disord., 24.","DOI":"10.1186\/s12872-024-04322-y"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5267\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T14:41:55Z","timestamp":1783348915000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5267"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":32,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15135267"],"URL":"https:\/\/doi.org\/10.3390\/jcm15135267","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]}}}