Key result
In situ laser fenestrations cut fabric defects by ~100% versus custom-made fenestrations in bench testing.
Why the study?
Long-term mechanical stability and durability of in situ laser fenestration compared to custom-made fenestrated endografts under fatigue testing had not been previously evaluated.
Does in situ laser fenestration provide comparable biomechanical durability to custom-made fenestrated endografts in a bench-top fatigue model?
Does in situ laser fenestration provide comparable biomechanical durability to custom-made fenestrated endografts in a bench-top fatigue model?
Absolute Event Rate: 0% vs 60%
p-value: p=0.007
In situ laser fenestration demonstrated comparable durability and superior bridging stent-graft integrity compared to custom-made fenestrations in a bench-top fatigue model, supporting its use as a bailout strategy for urgent complex aortic repair.
Bench data favor in situ laser fenestration durability; leaves open clinical translation versus custom devices.
OBJECTIVE: This study evaluates the biomechanical performance and long-term durability of in situ laser fenestration (ISLF) compared to custom-made fenestrated endografts (CMD) using a controlled bench-top experimental setup. METHODS: In situ, laser fenestration was performed in a RelayPro Dacron endograft using a 2.0 mm Turbo Elite OTW Laser Atherectomy catheter. Ten BeGraft Bridging Stent-Grafts (BSG) were implanted in 5 ISLF and 5 CMD Zenith fenestrations and subjected to 50 million fatigue cycles. Fenestrations were evaluated radiographically and microscopically for shape, size, fraying, endograft tearing, and BSG integrity. RESULTS: ; median long axis: 5.83 mm, median short axis: 5.8 mm) immediately post-manufacturing (p=0.002), but increased significantly after stenting and fatigue (p=0.002). Tearing was observed in 3 of 5 ISLF after ballooning but resolved after BSG implantation. BSG integrity was superior in the ISLF group, with no all-layer defects, while 3 of the 5 tested BeGrafts used in the CMD group revealed fabric defects with partial fracture of the stent in 2 (p=0.007). CONCLUSION: ISLF fenestrations demonstrated comparable durability to CMD fenestrations after long-term fatigue testing, with distinct advantages in BSG integrity preservation. These findings support ISLF as a viable option for urgent treatment, although further research is warranted to validate these results.Clinical ImpactIn-situ laser fenestration is a feasible technique for urgent complex aortic repair when customized or off-the-shelf devices are unavailable or technically unfeasible. However, long-term mechanical stability and durability under fatigue testing have not been previously evaluated. This study is the first to directly compare the long-term mechanical performance of industry-made custom fenestrations with in-situ laser fenestrations using a fatigue model. Results demonstrate non-inferiority of in-situ laser fenestrations, supporting their use as an effective off-label strategy for emergency or bailout interventions.
No takes yet. Share an insight, caveat, or question.
Elger et al. (2025) studied Complex aortic repair (bench-top model) (n=10). In situ laser fenestration (ISLF) vs. Custom-made fenestrated endografts (CMD) was evaluated on Bridging Stent-Graft (BSG) integrity (fabric defects) (p=0.007). In a bench-top fatigue model, in situ laser fenestrations demonstrated superior bridging stent-graft integrity compared to custom-made fenestrations (0% vs 60% fabric defects; p=0.007).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: