A Systematic Review on Methods and Tools for the In Situ Fenestration of Aortic Stent-Graft

In situ fenestration of stent-graft represents a potential option for the treatment of aortic diseases in patients unsuitable for standard endovascular repair. The best fenestration strategy to restore perfusion of collateral vessels after their coverage by an endograft depends mainly on the anatomical area. Several tools are employed as fenestration devices, including needles, radiofrequency probes, and laser systems, used in conjunction with other instrumentation to provide enough support and stability during the procedure. In this systematic review, the approaches to reach the correct fenestration site both in human, animal, and in in vitro environments are described and discussed, highlighting advantages and limitations. Both commercial and dedicated solutions for the intraoperative modification of the fabric material are reported as well. The clinical interest in this procedure has so far encouraged researchers to develop and refine both methods and tools to solve the current limitations of this technique, intending to extend the indications for endovascular treatment to a broader range of patients.

Automated summary

In situ fenestration of stent-graft is a potential option for aortic disease treatment in patients unsuitable for standard endovascular repair. The choice of the best fenestration strategy depends on the anatomical area and aims to restore perfusion of collateral vessels. Various tools, such as needles, radiofrequency probes, and laser systems, are used in conjunction with other instruments to provide support and stability during the procedure. This systematic review discusses and describes the approaches used to reach the correct fenestration site in human, animal, and in vitro environments, highlighting advantages and limitations. Commercial and dedicated solutions for intraoperative modification of the fabric material are also reported. There is significant clinical interest in this procedure, leading researchers to develop and refine methods and tools to overcome current limitations and expand the indications for endovascular treatment in a broader range of patients.