Outcomes of Inner Branches in Endovascular Repair of Complex Abdominal and Thoracoabdominal Aortic Aneurysms.

OBJECTIVE: The aim of the present study was to report outcomes of inner branches of the Cook Platform in endovascular repair of complex abdominal (cAAAs) and thoracoabdominal aortic aneurysms (TAAAs). METHODS: All consecutive patients treated at two institutions with F/BEVAR for cAAA or TAAA using stent grafts with inner branches between April 2015 and December 2024 were included. Analysed endpoints included technical success, peri-operative mortality, target vessel patency, freedom from endoleak, target vessel related re-intervention, and target vessel instability (TVI) for vessels addressed with inner branches. RESULTS: A total of 108 patients (79 male, mean age 71 ± 8.9 years) with 181 inner branches were analysed. Nineteen (17.6%) patients had a cAAA and 89 (82.4%) patients a TAAA. A stent graft with fenestrations and inner branches was used in 92 (85.2%) patients. Thirty day mortality was 3.7% (4/108). Technical success per inner branch was 98.9% (179/181). Estimated patencies at 1 and 2 years were 95.0% ± 1.7%, and 90.5% ± 2.6%, respectively. Estimated patency at 2 years was lower for the renal arteries compared with the splanchnic arteries (80.4% ± 5.3% vs. 98.9% ± 1.1% respectively, p = .002). Estimated freedom from TVI for vessels treated with inner branches at 1 and 2 years was 93.3% ± 1.5% and 87.6% ± 2.2%, respectively. Estimated freedom from TVI at 2 years was higher for grafts with a combination of fenestrations and inner branches compared with grafts with inner branches only (91.4% ± 3.0% vs. 79.5% ± 6.5%, p = .022). CONCLUSION: Inner branches were associated with excellent technical success rates. Renal arteries were associated with higher occlusion rates at 2 years compared with splanchnic arteries. Grafts with a combination of inner branches and fenestrations might be preferable over grafts with inner branches only, presenting higher patency and lower TVI rates.