Optimizing the target vessel outcomes in patients managed with fenestrated and branched endovascular aortic arch repair.

Endovascular aortic arch repair has been applied in high-risk patients with highly acceptable early technical and clinical outcomes in large aortic centers. Despite the increasing literature in the field, target-vessel-related outcomes in patients managed with fenestrated and branched thoracic endovascular aortic repair (f/bTEVAR) have not been extensively investigated. Cohorts mainly reporting on the clinical findings of f/bTEVAR suggest high patency rates of up to 100% during mid-term follow-up, whereas re-interventions are mainly attributed to type Ic and IIIc endoleaks, especially in bTEVAR cases. Fenestrations, however, seem to be more prone to usually asymptomatic bridging stent stenoses due to kinking within the initial year of follow-up. Target-vessel-related re-interventions, regardless of the underlying approach, are minimal and usually performed successfully using endovascular means. However, until long-term findings are available in the literature, the fate of the bridging stents, target vessels, and, further patients managed with f/bTEVAR remains unknown. Studies focusing on patient-specific parameters, including the aortic arch and supra-aortic trunk anatomy, material evolution with dedicated bridging stents, which conform to the large target-vessel diameters and hemodynamics of the aortic arch, are scarce. Furthermore, clarifications on the impact of medical treatment on bridging stent performance and long-term outcomes are needed and will hopefully clarify the target-vessel-related outcomes in patients managed with f/bTEVAR.