Outcomes of multibranched off-the-shelf stent graft in elective and urgent/emergent repair of complex aortic aneurysms with narrow internal aortic lumen

• Published in: Journal of vascular surgery Vol. 76; no. 2; pp. 326 - 334
• Main Authors: Ferrer, Ciro, Orrico, Matteo, Spataro, Claudio, Coscarella, Carlo, Ronchey, Sonia, Marino, Mario, Giudice, Rocco, Mangialardi, Nicola
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2022
• Subjects: branched endovascular aortic repair; complex aortic procedures; narrow aortic lumen; off-the-shelf multibranched stent graft; thoracoabdominal aortic aneurysm; complex aortic procedures; thoracoabdominal aortic aneurysm; branched endovascular aortic repair; off-the-shelf multibranched stent graft; narrow aortic lumen; Narrow aortic lumen; Complex aortic procedures; Thoracoabdominal aortic aneurysm; Branched endovascular aortic repair; Off-the-shelf multibranched stent graft
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2022.03.007

To assess the outcomes of Cook t-Branch off-the-shelf multibranched stent graft (Cook Medical, Bloomington, IN, USA) in the treatment of complex aortic aneurysms with narrow internal aortic lumen. Between 2016 and 2020, 48 patients (mean age 73 years) underwent elective or urgent/emergent Cook t-Branch implantation for thoracoabdominal or para/juxtarenal aortic aneurysms in 2 Italian vascular centers. Among these, 20 patients presented a paravisceral/pararenal luminal diameter < 25 mm. Major clinical and radiological outcomes of patients with narrow aortic lumen were compared with patients with larger lumen in a multicenter, non-randomized, retrospective fashion. The in-hospital mortality was 10% (5% in the elective setting). Spinal cord ischemia occurred in 6% of the cases. During a mean follow-up of 18 months (range 1 – 63), late t-Branch procedure-related mortality and the need for re-intervention was 0% and 12%, respectively. Comparing the outcomes of patients with large internal aortic lumen (Group 1) with patients with small lumen (Group 2), no significant difference was found regarding fluoroscopy time (p = 0.3), technical success (p = 1), early (p = 0.4) and late (p = 1) mortality, spinal cord ischemia (p = 0.2), bowel ischemia (p = 0.5), renal (p = 0.7), cardiac (p = 1), and respiratory complications (p = 1), re-intervention rate (p = 1), and primary patency rate of stented target vessels (p = 1). The use of the Cook t-Branch in our experience was safe and effective in the treatment of complex aortic aneurysms regardless the caliber of the aortic lumen. With all the limitations of a small sample size, this approach has demonstrated to be feasible also when maneuverability is reduced, with low mortality and morbidity, and acceptable re-intervention need. Perioperative mortality remains closely related to clinical presentation. Large-scale studies are needed to confirm these results. Type of Research: Multicenter, non-randomized, retrospective studyKey Findings: Endovascular repair of complex aortic aneurysm with Cook t-Branch stent graft, in patient with narrow internal aortic lumen, resulted in similar technical success rate (96% vs. 95%), target vessel primary patency (99% vs. 99%), and need for re-intervention (11% vs. 15%) when compared to patients with larger internal aortic lumen.Take home Message: The use of the Cook t-Branch in our experience was safe and effective in both the elective and urgent/emergent treatment of complex aortic aneurysms regardless the caliber of the internal aortic lumen.