Purpose: To present early and midterm results of
the periscope endograft (PG) technique to maintain left subclavian artery (LSA)
blood flow in thoracic endovascular aortic repairs (TEVAR) involving zone 3.
Methods: From April 2010 to January 2013, 14
consecutive high-risk patients (11 men; mean age 70±8 years, range
56–87) underwent TEVAR with the PG technique for 10 thoracic aortic
aneurysms (TAA), 2 traumatic aortic ruptures, and 2 aortic dissections without a
suitable landing zone (>2 cm distal to the LSA). Five procedures were
performed emergently for rupture (3 TAAs and the 2 trauma cases). Two patients
had a periscope deployed in an aberrant right subclavian artery. The periscope
endografts were sized 1 to 2 mm larger than the branch artery at the intended
landing zone. The caudal end was extended distal to the intended distal landing
site of the thoracic stent-graft, which was usually deployed after the PG. Both
the PG and thoracic stent-grafts were generally molded using the kissing balloon
technique. Outcomes analyzed were immediate technical success, perioperative
mortality and morbidity, aneurysm diameter change, and periscope endograft
patency.
Results: Immediate technical success was
100%, with all procedures completed as planned. Perioperatively, one
periscope occluded and one of the ruptured TAA patients died. One percutaneous
access site hematoma required only conservative management. At a mean follow-up
of 26±9 months (range 9–37), there was no additional PG occlusion.
The Kaplan-Meier estimate of PG patency was 93% at 2 years.
Conclusion: The periscope endograft is a simple
technique to maintain perfusion to the LSA in cases where the aortic stent-graft
crosses its ostium. The PG technique can be performed transfemorally and even
percutaneously, and it can be applied to all supra-aortic branches. Early and
midterm results are encouraging, but more experience and long-term results are
mandatory before this technique can be widely recommended.
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