Laser in situ fenestrated endograft (LIFE) repair of complex aortic arch pathology: Early outcomes from the multicenter LIFE registry.
Publication Title
Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
Document Type
Article
Publication Date
10-9-2025
Keywords
oregon; portland; cards; cards publication
Abstract
OBJECTIVE: Endovascular repair of aortic arch pathologies is limited by currently available device configurations, variation in aortic arch anatomy, access challenges, and frequent nonelective surgical acuity. The present study aims to assess the feasibility and midterm outcomes of laser in situ fenestrated endograft (LIFE) repair for supra-aortic arch branches during thoracic endovascular repair (TEVAR).
METHODS: Patients who underwent LIFE during TEVAR for aortic arch pathologies (2017-2022) were retrospectively identified at six high-volume centers, and data were collected in the multicenter LIFE registry. Descriptive statistics and Kaplan-Meier analysis were used. Primary outcomes were technical success, stroke, and target vessel instability. Secondary outcomes included 30-day mortality, spinal cord ischemia, and reinterventions.
RESULTS: A total of 82 patients who underwent LIFE with supra-aortic arch involvement were included. The mean age was 62.4 years (29.3% female and 78.0% White). Select demographics of the cohort featured previous stroke in 17.1% of cases, chronic lung disease in 12.2%, and renal insufficiency in 30.5%. Indication(s) for TEVAR included type B aortic dissection in 70.7% of cases, aneurysm in 11.0%, and penetrating atherosclerotic ulcer/intramural hematoma in 4.9%. Repair was performed for nonelective pathologies in 47.9% of cases. Eighty-nine supra-aortic arch branch vessels (innominate, n = 6; left common carotid artery, n = 9; and left subclavian artery, n = 74) were incorporated via LIFE to achieve proximal seal in zone 0 (19%), zone 1 (5%), and zone 2 (75%). LIFE repair was performed for a single-branch vessel in 90% of cases and a double-branch vessel in 10%. Ten patients underwent adjunctive extra-anatomic bypass. Technical success was achieved in 95.1% of cases. Thirty-day mortality was 2.4% (n = 2). Early (< 30 days) neurologic outcomes included a stroke and spinal cord ischemia rate of 7.4% and 0%, respectively. At a mean follow-up of 15 months (range, 1-81 months), there were 5 additional late deaths (6.1%). A total of 8 patients (9.8%) required 11 unplanned reinterventions at a mean of 423 ± 555 days (range, 17-1479 days) postoperatively. Kaplan-Meier estimated survival was 94.5% at 36 months, and reintervention-free survival was 78.0% at 36 months.
CONCLUSIONS: Results from the multicenter LIFE registry demonstrate laser in situ fenestration of complex aortic arch anatomy to be technically feasible with a perioperative mortality and neurologic risk profile that is comparable to standard techniques. Despite a modest reintervention rate in this early experience, midterm survival is excellent, particularly given the high-risk aortic pathologies and patient demographics featured in this cohort. Although perioperative results and midterm outcomes remain promising, longitudinal data are needed to confirm durability of this technique.
Area of Special Interest
Cardiovascular (Heart)
Specialty/Research Institute
Center for Cardiovascular Analytics, Research and Data Science (CARDS)
Specialty/Research Institute
Cardiology
Specialty/Research Institute
Surgery
DOI
10.1016/j.jvs.2025.09.056
