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

Ferrer, Ciro; Orrico, Matteo; Spataro, Claudio; Coscarella, Carlo; Ronchey, Silvia; Marino, Mario; Giudice, Rocco; Mangialardi, Nicola

doi:10.1016/j.jvs.2022.03.007

Cited by 16 publications

(5 citation statements)

References 20 publications

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“…In this analysis, the t-Branch device was used to treat a variety of emergent and urgent cases, including thoracoabdominal, juxta- and para-renal aneurysms with an early mortality of 16.8% for the total cohort and 26% for the emergent cases. These findings align to the available literature reporting on 17% 30-day and 25% in-hospital mortality in patients needing urgent complex endovascular repair ( 23 , 24 ).…”

Section: Discussionsupporting

confidence: 91%

“…including thoracoabdominal, juxta-and para-renal aneurysms with an early mortality of 16.8% for the total cohort and 26% for the emergent cases. These findings align to the available literature reporting on 17% 30-day and 25% in-hospital mortality in patients needing urgent complex endovascular repair (23,24). Off-the-shelf solutions represent the main approach in patients needing urgent complex aortic repair, including parallel grafts, physician modified endografts with in-situ fenestrations or ontable modifications, and off-the shelf branched devices (21,22).…”

Section: Discussionsupporting

confidence: 86%

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Urgent and emergent repair of complex aortic aneurysms using an off-the-shelf branched device

Nana,

Spanos,

Jakimowicz

et al. 2023

Front. Cardiovasc. Med.

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IntroductionEndovascular repair using off-the-shelf endografts is a viable solution in patients with ruptured or symptomatic complex aortic aneurysms. This analysis aimed to present the peri-operative and follow-up outcomes in urgent and emergent cases managed with the t-Branch multibranched thoracoabdominal endograft.MethodsProspectively collected data from all consecutive urgent and emergent cases managed in two aortic centers between January 1st, 2014, to November 30th, 2022, using the t-Branch device (Cook Medical Inc., Bjaeverskov, Denmark) were analyzed. Patients presenting with ruptured aortic complex aneurysms were characterized as emergent and patients with aneurysms >90 mm of diameter, or symptomatic aneurysms were characterized as urgent. Technical success, 30-day mortality, major adverse events (MAE) and spinal cord ischemia (SCI) rates were assessed.Results225 patients (36.5% females, 72.5 ± 2.8 years) were included; 73.0% were urgent. The mean aneurysm diameter was 109 ± 3.9 mm and 44.4% were type I–III TAAAs. Females (p = .03), para-renal aneurysms (p = .02) and ASA score IV (p < .001) were more common in emergent cases. Technical success was 97.8%. Thirty-day mortality and MAE rates were 17.8% and 30.6%, respectively. SCI rate was 14.7%, (4.8% paraplegia rate) with 22.2% of patients receiving prophylactic cerebrospinal drainage. Thirty-day mortality (13.3% vs. 26.7%, p = .04) and MAE (26.0% vs. 43.0%, p = .02) were more common among emergent cases while technical success (97.6% vs. 98.3%, p = .9), and SCI (13.3% vs. 18.3%, p = .4) were similar. Survival at 12-months was 83.5% (SE 5.9%) for the urgent and 77.1% (SE 8.2%) for the emergent group (log rank, p = 0.96).ConclusionT-Branch represents an effective and safe solution for the management of urgent and emergent cases with complex aortic aneurysms, with high technical success, promising early mortality and SCI rates.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 86%

Urgent and emergent repair of complex aortic aneurysms using an off-the-shelf branched device

Nana,

Spanos,

Jakimowicz

et al. 2023

Front. Cardiovasc. Med.

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“…This non-negligible limitation is expected to be much higher in cases of juxta/pararenal aneurysms or type Ia endoleaks post previous endovascular aortic repair, conditions in which branched endografts are nowadays increasingly employed both in urgent and elective scenarios [ 11 , 12 , 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ferrer et al recently reported a two-center experience using the T-branch endograft, where 41.7% of patients had an internal aortic diameter measuring less than 25 mm at the paravisceral/pararenal level [ 14 ]. Notably, similar outcomes were observed between this narrow-lumen population and the remaining patients.…”

Section: Discussionmentioning

confidence: 99%

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Partial Deployment to Save Space for Vessel Cannulation When Treating Complex Aortic Aneurysms with Narrow Paravisceral Lumen Is Also Feasible Using Inner-Branched Pre-Cannulated Endografts

Simonte,

Gatta,

Vento

et al. 2024

JCM

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Introduction: The aim of this paper is to propose a sequential deployment technique for the E-nside off-the-shelf endograft that could potentially enhance target visceral vessel (TVV) cannulation and overstenting in narrow aortic anatomies. Methods: All data regarding patients consecutively treated in two aortic centers with the E-nside graft employing the partial deployment technique were included in the study cohort and analyzed. To execute the procedure with partial endograft deployment, the device should be prepared before insertion by advancing, under fluoroscopy, all four dedicated 400 cm long 0.018″ non-hydrophilic guidewires until their proximal ends reach the cranial graft’s edge. Anticipating this guidewire placement prevents the inability to do so once the endograft is partially released, avoiding potentially increased friction inside the constricted pre-loaded microchannels. The endograft is then advanced and deployed in the standard fashion, stopping just after the inner branch outlets are fully expanded. Tip capture is released, and the proximal end of the device is opened. Visceral vessel bridging is completed from an upper access in the desired sequence, and the graft is fully released after revascularizing one or more arteries. Preventing the distal edge of the graft from fully expanding improves visceral vessel cannulation and bridging component advancement, especially when dealing with restricted lumina. Results: A total of 26 patients were treated during the period December 2019–March 2024 with the described approach. Procedure was performed in urgent settings in 14/26 cases. The available lumen was narrower than 24 mm at the origin of at least one target vessel in 11 out of 26 cases performed (42.3%). Technical success was obtained in 24 out of 26 cases (92.3%), with failures being due to TVVs loss. No intraoperative death or surgical conversion was recorded, and no early reintervention was needed in the perioperative period. Clinical success at 30 days was therefore 80.7%. Conclusions: The described technique could be considered effective in saving space outside of the graft, allowing for safe navigation and target vessel cannulation in narrow visceral aortas, similar to what has already been reported for outer-branched endografts.

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Expert-Based Narrative Review on Contemporary Use of an Off-The-Shelf Multibranched Endograft for Endovascular Treatment of Thoracoabdominal Aortic Aneurysms: Device Design, Anatomical Suitability, Technical Tips, Perioperative Care, Clinical Applications, and Real-World Experience

Chen,

Bashir,

Guo

et al. 2024

Annals of Vascular Surgery

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

Cited by 16 publications

References 20 publications

Urgent and emergent repair of complex aortic aneurysms using an off-the-shelf branched device

Urgent and emergent repair of complex aortic aneurysms using an off-the-shelf branched device

Partial Deployment to Save Space for Vessel Cannulation When Treating Complex Aortic Aneurysms with Narrow Paravisceral Lumen Is Also Feasible Using Inner-Branched Pre-Cannulated Endografts

Expert-Based Narrative Review on Contemporary Use of an Off-The-Shelf Multibranched Endograft for Endovascular Treatment of Thoracoabdominal Aortic Aneurysms: Device Design, Anatomical Suitability, Technical Tips, Perioperative Care, Clinical Applications, and Real-World Experience

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