Early results of aortic arch diseases treatment using the custom made fenestrated Najuta endograft

BACKGROUND: Aortic arch diseases represent a challenge for surgeons, especially in patients already submitted to urgent type A aortic dissection repair. Possible alternatives of treatment are represented by redo-surgery, TEVAR associated with supra-aortic debranching, branched or fenestrated endografts.METHODS: Between September 2023 and December 2024 we treated four patients with custom-made fenestrated Najuta endograft: three patients had residual non-A, non-B aortic dissection after type A aortic dissection urgent repair. One patient had a descending thoracic aorta dissection complicated by voluminous aneurysm.RESULTS: All patients were operated in the hybrid room of our hospital under general anesthesia, using the Najuta fenestrated endograft, recurring to the pull through technique. No one had intraoperative complications. Only one patient presented post-operative heart failure, submitted to coronary artery angioplasty and Covid-19 infection. No endoleaks nor collapse/migration of the endograft were detected at 6-12 months. Traditional TEVAR has the limit of an adequate proximal aortic landing zone and often requires supra-aortic debranching, with risk of perioperative stroke and the limit of bird beak phenomenon. Custom-made fenestrated endografts, such as the Najuta endograft, offers the possibility to extend the endovascular treatment to so challenge diseases, reducing the pulmonary and heart complications and the in-hospital stay, preserving antegrade flow to supra-aortic vessels and offering a proximal landing zone from zone 0 to zone 2.CONCLUSIONS: We presents preliminary results about 4 patients affected by aortic arch diseases treated in our Institute with the custom-made fenestrated Najuta endograft, that are promising and encouraging.