In Vitro Comparison of Retrograde In Situ Fenestration Using a Re-entry Catheter vs Electrified Guidewire in Thoracic Endografts
Year: 2025
Type: article
Abstract: Objective: To compare the in vitro feasibility and fenestration characteristics of 2 in situ fenestration (ISF) techniques—re-entry catheter (REC-ISF) and electrified guidewire (EW-ISF)—in commercially available thoracic stent-grafts. Methods: Forty in vitro fenestrations were performed in RelayPro and Valiant endografts using either REC or EW (n=10 per graft per technique). The grafts were completely submerged in a saline bath at 37°C, mimicking physiological temperature. All fenestrations were sequentially balloon dilated with 2 mm and 6 mm plain balloons. Outcomes fenestration geometry and fabric damage, and puncture and dilatation success, defined as success in penetrating the graft and success in advancing the balloons, respectively. The fenestration area was measured immediately after dilatation and after 24 hours to evaluate elastic recoil. Results: Initial puncture succeeded in 60% of REC-ISF cases in RelayPro and 70% in Valiant, whereas EW-ISF achieved 100% puncture success across both grafts (p<0.05). In the Valiant graft, balloon dilatation was successful in 9/10 cases with EW-ISF, but in 0/10 cases with REC-ISF (p<0.001), as the 2 mm balloons could not be advanced within the fenestration holes. For both methods, the dilatation was, however, successful in all fenestrations in the RelayPro. In this graft, post-dilatation fenestration areas were similar between techniques (6.0 vs 6.01 mm 2 ; p=0.809), but tearing occurred more frequently with EW-ISF (80% vs 0%, p<0.001). The REC-ISF produced elliptical, weft-aligned fenestrations; EW-ISF yielded variable shapes aligned with the warp. After 24 hours, REC-ISF fenestrations showed greater surface recoil than EW-ISF in RelayPro (23.1% vs 5.0%; p=0.037). Conclusion: The EW-ISF showed high technical feasibility across both analyzed grafts, producing consistent, easily reproducible, and dimensionally stable fenestrations. In contrast, REC-ISF demonstrated material-dependent technical limitations under the constraints of this model. These findings support the use of EW-ISF as an off-the-shelf ISF option in emergency settings when other fenestration tools (ie, excimer laser) are unavailable, even if a head-to-head comparison is warranted. Clinical Impact This paper presents a proof-of-concept evaluation of two newly described off-the-shelf techniques for in situ fenestration (ISF) in thoracic stent-grafts: electrified guidewire ISF (EW-ISF) and re-entry device ISF (RED-ISF). The findings demonstrate a clear technical advantage of EW-ISF, which achieved higher puncture success, more reproducible fenestration geometry, and greater dimensional stability compared with RED-ISF. As such, EW-ISF emerges as a more reliable off-the-shelf option when dedicated fenestration tools—such as excimer lasers—are unavailable. These results may broaden endovascular treatment possibilities in time-critical or anatomically challenging scenarios, ultimately enhancing procedural success and branch preservation during emergency thoracic aortic interventions.
Source: Journal of Endovascular Therapy
Institutions: Universitätsmedizin Göttingen, University of Göttingen
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,400
OpenAlex ID: W7117382544