Key result
Laser in-situ fenestration for LSA revascularization yields high technical success and low risk despite uncertain durability.
Why the study?
When TEVAR requires left subclavian artery coverage, surgical bypass carries notable morbidity, prompting a summary of existing knowledge on laser and radiofrequency in-situ fenestration alternatives.
Do laser in-situ fenestration and radiofrequency fenestration provide safe and effective left subclavian artery revascularization during TEVAR?
Do laser in-situ fenestration and radiofrequency fenestration provide safe and effective left subclavian artery revascularization during TEVAR?
Laser and radiofrequency in-situ fenestration offer high technical success and low perioperative risk for left subclavian artery revascularization during TEVAR, though long-term durability requires further study.
Supports laser in-situ fenestration for LSA revascularization during TEVAR; leaves open long-term durability pending further study.
Thoracic endovascular aortic repair (TEVAR) is standard for descending thoracic aortic disease. When disease involves the proximal arch (zones 0-3), left subclavian artery (LSA) coverage is often required, increasing stroke and spinal cord ischaemia risk if unrevascularized. Guidelines recommend routine LSA revascularization, traditionally via surgical bypass, though with notable morbidity. Endovascular alternatives include fenestrated/branched devices, chimneys, and in-situ fenestration. This narrative review aims to provide a summary of existing knowledge on laser in-situ fenestration (ISLF) and radiofrequency fenestration for LSA revascularization. ISLF provides high technical success, durable patency, and low perioperative risk, with expanding use in urgent and complex cases. Long-term durability, however, remains uncertain and requires further study.
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Saricilar et al. (2026) studied this question. Laser in-situ fenestration for left subclavian artery revascularization yields high technical success, durable patency, and low perioperative risk, but long-term durability remains uncertain.
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