Total Endovascular Aortic Arch Repair Using In Situ Needle Triple Fenestration and Selective Cerebral Perfusion: Single-Center Results

<b>Background:</b> Advances in stent grafts and endovascular techniques have expanded the indications for thoracic endovascular aortic repair (TEVAR) to include arch lesions. In situ needle fenestration (ISNF) has emerged as a promising technique for revascularizing supra-aortic branches. The aim of this study is to evaluate the safety and efficacy of triple in situ needle fenestration during TEVAR for aortic arch pathologies in a single-center experience. <b>Materials and Methods:</b> A retrospective analysis was conducted on fifteen patients who underwent in situ triple fenestration TEVAR between June 2023 and March 2024. The median age of the patients was 51,33 years (±19.69) and twelve of the patients were male. All procedures were performed under general anesthesia in a hybrid operating room. Ethical approval was obtained from the institutional review board, and informed consent was received from all participants. <b>Results:</b> Primary technical success was achieved in all cases (15/15, 100%). The mean operation time was 197.33 min (range: 126-302). Two patients experienced a minor hematoma at the access site. Mortality was observed in one patient (6.66%) during the 30-day follow-up period. The total hospital stay averaged 7 ± 3.36 days. One patient had a transient ischemic attack, but there were no incidents of stroke or spinal cord ischemia. No procedure-related endoleak was observed during the intervention; however, eight patients required reintervention in the descending aorta. <b>Conclusions:</b> ISNF may be an effective and feasible method for revascularizing arch vessels, with low rates of early mortality and stroke when performed by experienced practitioners. However, larger multicenter studies with longer follow-up are needed to confirm the durability and long-term outcomes of this technique.