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

OBJECTIVE: To report outcomes of endovascular repair of complex (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs) by an off-the-shelf mutibranched thoracoabdominal endograft (T-Branch; Cook Medical). 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, target artery (TA) instability, and survival were assessed during follow-up. RESULTS: Of 130 cases, 71 (55%) and 59 (45%) patients were managed in urgent and elective setting, respectively. One hundred fifteen (89%) cases were TAAAs, and 15 (11%) were juxtarenal/pararenal aneurysms. Sixty-seven (52%) cases were performed outside the manufacturer'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 = .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 = .02; odds ratio [OR]: 9; 95% confidence interval [CI]: 1.4-58.9) and postoperative mesenteric events (P = .01; OR: 30; 95% CI: 2.1-424.2) were risk factors for SCI. Twelve (9%) patients died within 30 days (elective: 7% vs urgent: 11%). Urgent setting (P = .03; OR: 5; 95% CI: 1.5-30.2), iliac conduit (P = .05; OR: 5; 95% CI: 1.3-9.2), and postoperative cardiac morbidity (P = .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 freedom from TA occlusion, instability, and reinterventions was 89%, 92%, and 70%, respectively. Urgent TAAA repair (P = .003; hazard ratio [HR]: 2; 95% CI: 1.1-4.2) and Crawford's extent I-III (P = .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 = .03; HR: 3; 95% CI: 1.4-5.8), paraplegia (P = .04; HR: 10; 95% CI: 1.1-86.1), and major adverse events (P = .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 midterm TA instability, reinterventions, and survival. Predictors of early/midterm failures were identified, and they should be considered to optimize patient selection and postoperative management.