A Novel Sheath Aligning Method of Left Subclavian Artery Revascularization in TEVAR

Concomitant left subclavian artery (LSA) fenestration is recommended in thoracic endovascular aortic repair (TEVAR) for revascularization when the LSA is covered. However, the sheath alignment lacks an accurate and efficient positioning method due to the angulation of LSA anatomy. We developed a novel method for sheath aligning characterized by the guiding catheter's front junction (J.) with the graft stent and descending (D.) aorta proceeding. It forms a curved traction system that drags the puncture needle to the center of LSA orifice. A 93.8% endoleak-free rate was observed during the 9.0 (4.0-17.5) months follow-up in 137 patients. No reintervention or mortality was observed. Our sheath aligning method can be safely performed in LSA fenestration, which simplifies the surgical procedure and may help to avoid iatrogenic complications.