Abstract
BACKGROUND: Thoracic aortic fenestration is one of the methods employed for aortic arch reconstruction. To address the technical complexities of conventional fenestrated thoracic endovascular aortic repair (f-TEVAR) for aortic diseases involving the arch, we developed a streamlined approach using a novel physician-modified Relay nonbare stent graft (Terumo Aortic), eliminating the need for time-consuming marker suturing or guidewire-assisted fenestration alignment. This study evaluated the clinical application of this minimalist modification protocol. METHODS: This retrospective cohort study analyzed 33 patients undergoing minimalist f-TEVAR with Relay nonbare stent-grafts between January 2023 and December 2023 in Beijing Anzhen Hospital, with precise preoperative electrocardiography-gated, computed tomography angiography-guided fenestration planning being applied. The stent graft's proprietary self-alignment mechanism enabled marker-free orientation via its precurved design and 12/6 o'clock markers. Intraoperative modifications included partial deployment, low-temperature fenestration punching, and simplified resheathing with dual-layer delivery. The primary endpoints were technical success, stent-graft modification time, fluoroscopy time, procedure time, endoleak rate, procedure-related complications, length of stay, and 30-day and late mortality. RESULTS: The cohort (mean age 63.2±10.6 years; 75.8% male) comprised patients with variety of aortic diseases, including penetrating ulcers (42.4%), type-B dissections (27.3%), non-A non-B dissections (18.2%), and aneurysms (12.1%). The modified protocol proved to be efficient : the graft modification time was 6.8±1.8 minutes, the fluoroscopy exposure was 8.2±3.9 minutes, and the total procedure time was 57.9±13.1 minutes. All procedures achieved technical success (100%), with no instances of endoleak, retrograde dissection, or neurological complications. All patients survived after a mean follow-up of 12.6±3.7 months. Supra-arch branches were all patent by the end of follow-up. CONCLUSIONS: Our experience demonstrates that the Relay nonbare stent-graft self-aligning design enables safe and efficient fenestration while maintaining excellent sealing properties and branch vessel patency. This stent-graft selection strategy provides a reliable foundation for simplified arch repair, potentially expanding the accessibility of complex endovascular aortic interventions.