Total Transfemoral Percutaneous Endovascular Aortic Arch Repair Using 3-Vessel Inner Branch Stent-Graft

Purpose: The purpose was to demonstrate a new arch endograft configuration to allow total endovascular aortic arch repair exclusive from transfemoral approach. Technique: The custom-made multi-branched arch endograft (Cook Medical, Bloomington, Indiana) features 3 inner branches (IBs) for supra-aortic vessels incorporation and complete endovascular arch repair. Traditionally, the innominate and left carotid branches are anterograde IBs, requiring upper access for incorporation of these vessels, and the left subclavian branch is an upward-facing IB that can be incorporated from transfemoral access. We report a novel device configuration with only upward-facing IBs, allowing exclusive transfemoral route for total endovascular arch repair. Technical aspects, implantation technique, and limitations are described thoroughly. Conclusion: Herein is described an arch endograft configuration that simplifies endovascular aortic arch repair, allowing supra-aortic vessel incorporation through a transfemoral route only. This innovative design may serve as another alternative in selected patients. Clinical Impact This innovative endograft design, with only upward-facing inner branches, simplifies the total endovascular aortic arch repair by allowing for a exclusively transfemoral approach. This may reduce procedural complexity and minimizes risks associated with multiple access points. It provides another alternative, particularly beneficial for selected high-risk patients for open repair, potentially expanding the applicability of endovascular treatments for aortic arch pathologies.

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Technical tips and clinical experience with the Cook Triple inner arch branch stent-graft

Tenorio

Vacirca

Mesnard

et al. 2023

J Cardiovasc Surg

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Open surgical repair remains the gold standard for treatment for aortic arch diseases, but these operations can be associated with wide heterogeneity in outcomes and significant morbidity and mortality, particularly in elderly patients with severe comorbidities or those who had prior arch procedures via median sternotomy. Endovascular repair has been introduced as a less invasive alternative to reduce morbidity and mortality associated with open surgical repair.The technique evolved with new device designs using up to three inner branches for incorporation of the supra-aortic trunks. This manuscript summarizes technical tips and clinical experience with the triple inner arch branch stent graft for total endovascular repair of aortic arch pathologies.

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Total Transfemoral Percutaneous Endovascular Aortic Arch Repair Using 3-Vessel Inner Branch Stent-Graft

Cited by 3 publications

References 4 publications

Endovascular Options for the Ascending Aorta and Aortic Arch: A Scoping Review

Endovascular Options for the Ascending Aorta and Aortic Arch: A Scoping Review

Technical Aspects of Exclusive Transfemoral Route for Total Endovascular Arch Repair: A Custom-Made Device With Only Upward-Facing Inner Branches for Aortic Arch Treatment

Technical tips and clinical experience with the Cook Triple inner arch branch stent-graft

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