Reintervention
Finally, it is worth considering the relative risk of patients having to
undergo subsequent procedures following FET arch repair. One primary
advantage of the FET procedure over conventional ET prosthesis is the
drastically reduced incidence of reintervention after the initial
procedure.4 While it is challenging to directly
attribute the need for reintervention to differences between Z-0-FET and
Z-2-FET, it is likely that the need for reintervention is linked to the
degree of positive aortic remodelling and FL thrombosis following
prosthesis implantation.25 It appears that Z-0-FET may
be associated with lower rates of reintervention than Z-2-FET: while
Yamamoto et al. highlight 7 cases of thoracic endovascular aortic
repair (TEVAR) attributed to FL enlargement (n=2), TL stenosis (n=3),
proximal anastomotic rupture (n=1), and bowel resection (n=1), 12%
(n=19) of patients in Jakob and colleague’s Z-2-FET report underwent
aortic reintervention due to disease progression.16,
23 A further 7% (n=7) of patients in Beckmann’s trial underwent
subsequent aortic replacement.12