Off-the-shelf multibranched endograft for urgent endovascular repair of thoracoabdominal aortic aneurysms

Abstract

The off-the-shelf multibranched endograft is a safe and effective therapeutic option for urgent total endovascular TAAA repair for which a custom-made endograft is not obtainable in due time. However, the complex anatomy of these aneurysms needs a number of adjunctive and complex intraoperative procedures to achieve a durable repair.

Standard “off-the-shelf” multibranched thoracoabdominal endograft in urgent and elective patients with single and staged procedures in a multicenter experience

“…Technical success in this study was encouraging. Overall mortality #30 days (4%) was in line with other published series dedicated to the t-Branch device (range, 0%-6%) [14][15][16] despite the majority of patients electively treated in these studies. The outcome was also lower than in other CSG cohorts (range, 7%-11.6%).…”

“…As noted previously, 16,28 the fixed length of the Zenith t-Branch device determines a higher coverage of the nondiseased aorta compared with the CSG and may determine a higher risk, especially in short extended disease. The authors agree with the suggested modifications designed to reduce proximal sealing and to increase the proximal diameter.…”

“…To date, there have been few published studies dedicated to the Zenith t-Branch device in selected patients (most were treated electively) 14,15 or a small cohort (n ¼ 17) of urgent/emergent repair. 16 This study is the largest series of elective and urgent/emergent patients (n ¼ 32 [44%]) available. The groups were generally similar at baseline, and as is commonly recognized in the literature, 1 urgent/emergent repair was found to increase the risk of both death (by as much as 20 times) and adverse events.…”

“…The SCI rate (3%) reported in this series was lower than the rates reported in literature dedicated to TAAA surgery (range, 5%-13.2%) 1,2 and mbEVAR (range, 5%-17%). 14,16,25 In the two cases of SCI, both patients received minimum aortic coverage (Crawford type IV), and intraoperative prophylactic CSFD was not given. Extended aortic coverage has been identified as one of the most important risk factors for SCI.…”

“…The initial clinical experiences showed interesting early results in both elective and urgent settings, but larger cohorts and longer follow-up are needed to verify this device. [13][14][15][16] The Italian mbEVAR study group performed a retrospective study to assess immediate and midterm outcomes for both urgent and elective TAAA patients treated with the first off-the-shelf mbEVAR, with a single-step or staged surgical approach.…”