<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1646-706X</journal-id>
<journal-title><![CDATA[Angiologia e Cirurgia Vascular]]></journal-title>
<abbrev-journal-title><![CDATA[Angiol Cir Vasc]]></abbrev-journal-title>
<issn>1646-706X</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Angiologia e Cirurgia Vascular]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1646-706X2024000400244</article-id>
<article-id pub-id-type="doi">10.48750/acv624</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[In-situ needle fenestration technique for preserving the left subclavian artery in emergent TEVAR]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Peixoto]]></surname>
<given-names><![CDATA[João]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Usai]]></surname>
<given-names><![CDATA[Marco Virgílio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Austermann]]></surname>
<given-names><![CDATA[Martin]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,ULS Vila Nova de Gaia/Espinho Serviço de Angiologia e Cirurgia Vascular ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,St. Franziskus-Hospital Münster Klinik für Gefäßchirurgie ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Germany</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2024</year>
</pub-date>
<volume>20</volume>
<numero>4</numero>
<fpage>244</fpage>
<lpage>247</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S1646-706X2024000400244&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S1646-706X2024000400244&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S1646-706X2024000400244&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Background:  Open aortic repair is the gold standard in the treatment of diseases involving the aortic arch, but high-risk patients are often not suitable candidates for surgical repair. Thoracic endovascular aortic repair (TEVAR) is less invasive; however, endovascular repair including the aortic arch remains a challenge. LSA revascularization is linked with reduced risk of cerebrovascular events, spinal cord ischemia, and upper limb ischemia at the cost of complications associated with carotid-subclavian bypass. In-situ fenestration (ISF) seems an effective, safe, and feasible method for the totally endovascular aortic arch repair avoiding the risks associated with bypass surgery. This technique allows for rapid, &#8220;off-the-shelf&#8221; repair of arch lesions with minimal physiologic disturbances and lower perioperative complications.  Case report:  An 86-year-old man is admitted to the emergency room due to chest pain and hoarseness. There was a previous medical history of TEVAR (proximally implanted in zone 3) for penetrating thoracic aortic; 8 months prior. Computed tomography angiography revealed aneurysmal dilation of the lesser curvature of the aortic arch with a maximum diameter of 65mm. The patient was submitted to TEVAR with proximal sealing in zone 2 of the arch (Ankura&#8482; stent-graft) and revascularization of the left subclavian artery (LSA) was achieved using an ISF by needle fenstration with the deployment of a balloon-expandable covered stent. No complications were registered. Patient initiated broad spectrum antibiotics and underwent positron emission tomography revealing several metabolically active lymph nodes suggesting underlying neoplasm.  Conclusion:  ISF, due to its relative simplicity, is also suitable in urgent and emergent settings. It is a simple, quick technique to be added to our arsenal of endovascular procedures on the aortic arch. It may avoid the carotid-subclavian bypass as well as intentional embolization of the LSA in urgent/emergent patients. Prospective studies with long-term clinical follow-up are still lacking to fully assess the durability of these fenestrations.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Thoracic aortic aneurysm]]></kwd>
<kwd lng="en"><![CDATA[endovascular repair]]></kwd>
<kwd lng="en"><![CDATA[TEVAR]]></kwd>
<kwd lng="en"><![CDATA[In situ Fenestration]]></kwd>
<kwd lng="en"><![CDATA[Left subclavian artery fenestration]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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