In Situ Laser Fenestration of the Left Subclavian Artery for TEVAR: A Systematic Review and Meta-Analysis

Objective To evaluate the outcomes after in situ laser fenestration of the left subclavian artery (LSA) for thoracic endovascular aortic repair (TEVAR). Methods The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The protocol was prospectively registered on PROSPERO (CRD420261457148). Data sources were the Cochrane Library, Embase, and MEDLINE. All studies reporting the outcomes of in situ laser fenestration of the LSA for TEVAR were eligible for inclusion. Quality assessment was performed using the Methodological Index for Non-Randomized Studies tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. A random-effects meta-analysis of proportions was conducted. Results Five studies encompassing 562 patients were included. The primary indication was type B aortic dissection (85%). The pooled technical success rate was 98.1% (95% confidence interval [CI], 96.6–99.2%). The pooled 30-day mortality was 2.1% (95% CI, 1.0–5.9%). The pooled incidence of target-vessel instability was 1.9% (95% CI, 0.3–4.5%), and the overall reintervention rate was 2.7% (95% CI, 0.4–6.4%). GRADE certainty was low to very low across outcomes. Conclusion LSA in situ laser fenestration demonstrates high technical success and favorable early clinical outcomes. Comparative trials against alternative endovascular strategies are required to establish its long-term durability and safety.