Needle INsitu Fenestration Aortic repair (NINFA) – Short term results of a multicentre registry

Summary: Background: Thoracic endovascular aortic repair (TEVAR) involving the left subclavian artery (Ishimaru zone 2) presents technical challenges. This multicentre study evaluates the Ankura thoracic stent graft with in-situ fenestration using a dedicated needle system (Lifetech, Shenzhen, China) for various thoracic aortic pathologies. Patients and methods: Between January 2020 and December 2025, 59 patients from three tertiary centres underwent in-situ fenestration TEVAR (if-TEVAR) for thoracoabdominal aortic pathologies. Clinical and imaging data were analysed, focusing on technical success, complications, and mid-term outcomes. Results: Demographics and comorbidities were comparable across pathologies. The SVS/AAVS age score was higher in TAAA and PAU patients (p=.005). Dissection cases required more grafts (p=.027), larger proximal diameters (p=.022), and showed less distal oversizing in TAAA (p=.031). Differences were noted in fenestration time (p=.049), stent type (p=.032), and adjunctive procedures (p<.001). Technical success was 93.2% (55/59), with no significant variation among groups. One patient died within 30 days (2% mortality). ICU/hospital stays and complications were similar. Conclusions: if-TEVAR with the Ankura graft in zone 2 is feasible with acceptable outcomes. Larger studies with extended follow-up are needed to confirm durability.