A Systematic Review on Methods and Tools for the In Situ Fenestration of Aortic Stent-Graft

• Published in: IEEE reviews in biomedical engineering Vol. 16; pp. 348 - 356
• Main Authors: Piazza, Roberta, Carbone, M., Berchiolli, R. N., Ferrari, V., Ferrari, M., Condino, S.
• Format: Journal Article
• Language: English
• Published: United States IEEE 2023; The Institute of Electrical and Electronics Engineers, Inc. (IEEE)
• Subjects: Aneurysm; Animals; Aorta; Aortic; Aortic Aneurysm, Thoracic - etiology; Aortic Aneurysm, Thoracic - surgery; Arteries; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Cardiovascular system; endograft; Endovascular Procedures - adverse effects; Endovascular Procedures - methods; endovascular repair; Health services; Humans; Implants; in situ fenestration; Instrumentation; Patients; Prosthesis Design; Radio frequency; stent-graft; Stents; Surgery; Systematic review; Systematics; Task analysis; Treatment Outcome
• ISSN: 1937-3333; 1941-1189
• DOI: 10.1109/RBME.2021.3085484

In situ fenestration of stent-graft represents a potential option for the treatment of aortic diseases in patients unsuitable for standard endovascular repair. The best fenestration strategy to restore perfusion of collateral vessels after their coverage by an endograft depends mainly on the anatomical area. Several tools are employed as fenestration devices, including needles, radiofrequency probes, and laser systems, used in conjunction with other instrumentation to provide enough support and stability during the procedure. In this systematic review, the approaches to reach the correct fenestration site both in human, animal, and in in vitro environments are described and discussed, highlighting advantages and limitations. Both commercial and dedicated solutions for the intraoperative modification of the fabric material are reported as well. The clinical interest in this procedure has so far encouraged researchers to develop and refine both methods and tools to solve the current limitations of this technique, intending to extend the indications for endovascular treatment to a broader range of patients.