The study aims to understand the efficiency and safety of using the ISNF (in-situ needle fenestration) method for LSA (left subclavian artery) reconstruction during TEVAR (thoracic endovascular aortic repair) in individuals with complicated aortic arch problems.

It is a retrospective study conducted on 50 patients who had ISNF for revascularizing LSA during TEVAR treatment. 21 subjects required treatment in LCCA (left common carotid artery) and IA (innominate artery). In total, 73 branches underwent revascularization.

ISNF was a success in 48 patients. In one case, the doctors could not stent the LSA, and in another, the LSA prevented fenestration. No major adverse situation occurred. There was no incidence of type I endoleak. There were four incidences of type III endoleaks. The type II endoleak and IV endoleak were found in 3 and 6 individuals, respectively. There was no such incidence at the 15-month follow-up. One subject died due to cerebral hemorrhage, and two required open reintervention.

ISNF is a feasible and safe method with a mid-term outcome. The patient selection criteria and the learning curve can affect clinical success, complications, and reintervention. The long-term durability is not studied here.