Ten-year experience in the endovascular repair of complex and thoracoabdominal aortic aneurysms by an off-the-shelf multibranched thoracoabdominal endograft

Objectives: To report outcomes of endovascular repair of complex (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs) by an off-the-shelf muti-branched thoracoabdominal endograft (T-Branch; Cook, Medical, Bloomington, IND, US). Methods: This single-center, retrospective study, analyzed all consecutive CAAAs and TAAAs managed in elective and urgent setting by T-Branch, between 2014 and 2024. Outcomes were reported according to the Society for Vascular Surgery reporting standards. Technical success (TS), spinal cord ischemia (SCI) and 30-day mortality were assessed as early outcomes. Freedom from reinterventions (FFRs), target arteries (TAs) instability and survival were assessed during follow-up. Results: Out of 130 cases, 71(55%) and 59(45%) patients were managed in urgent and elective setting, respectively. One hundred and fifteen (89%) cases were TAAAs and 15(11%) juxta/para-renal aneurysms. Sixty-seven (52%) cases were performed outside the manufacture's instructions for use (IFUs). TS was achieved in 118(91%) cases (elective:90% vs urgent:92%) without difference between cases inside and outside IFUs (inside:92% vs outside:90%; P=0.7). There were 10(8%) SCI events (elective:2% vs urgent:13%) with 3(2%) cases of paraplegia (elective:2% vs urgent:3%). Ruptured TAAAs (P=0.02;OR:9;95%CI:1.4-58.9) and post-operative mesenteric events (P=0.01;OR:30;95%CI:2.1-424.2) were risk-factors for SCI. Twelve (9%) patients died within 30-day (elective:7% vs urgent:11%). Urgent setting (P=0.03;OR:5;95%CI:1.5-30.2), iliac conduit (P=0.05;OR:5;95%CI:1.3-9.2) and postoperative cardiac morbidity (P=0.001;OR:15;95%CI:1.6-18.5) were risk-factors for 30-day mortality. The mean follow-up was 39+22 months. Estimated 3-year FF TAs occlusion, instability and reinterventions were 89%, 92% and 70%, respectively. Urgent TAAAs repair (P=0.003;HR:2;95%CI:1.1-4.2) and Crawford's extent I-III (P=0.04;HR:3;95%CI:1.1-5.9) were risk-factors for follow-up reinterventions. Estimated 3-year survival was 64%. Urgent TAAAs (P=0.03;HR:3;95%CI:1.4-5.8), paraplegia (P=0.04;HR:10;95%CI:1.1-86.1) and major adverse events (P=0.003;HR:2;95%CI:1.1-3.8) were risk-factors for follow-up mortality. Conclusions: Endovascular repair of CAAAs and TAAAs by T-Branch is effective with excellent early outcomes and satisfactory mid-term TAs-instability, reinterventions and survival. Predictors of early/mid-term failures were identified, and they should be considered to optimize patient selection and postoperative management.